肛瘘患者手术前后肛管直肠动力学研究

The outcome of anorectal manometry in pre-postoperation of anal fistula

目的利用肛管直肠测压技术,评价和分析肛瘘患者手术前后肛管直肠功能的变化。方法用肛管直肠测压方法对20例正常对照者,67例肛瘘患者,22例多次手术后患者进行肛管长度、肛管静息压、肛管最大收缩压、直肠压、直肠黏膜感觉功能检测。分别将正常对照组与肛瘘组、对照组与经手术组、肛瘘组与经手术组进行比较,分析肛管直肠功能的变化。结果肛瘘患者肛管静息压力及最大收缩压力大于正常人群(P<0.05),手术组和肛瘘组比较,肛管功能长度变短(P<0.05),肛管静息压力及收缩压力降低(P<0.05),直肠黏膜敏感性增加(P<0.05),与正常对照组比较,差异有统计学意义(P<0.05)。结论肛管压力的增加可能是肛瘘产生的一个病因之一,肛瘘患者多次手术以后,可能会造成肛门括约肌的损伤,从而影响肛管功能,临床应将肛管直肠测压技术推广应用于肛瘘患者手术前后肛门功能的评估。

Objective To evaluate the effect of operation on anorectal function in patients suffered with anal fistula by anorectal manometry. Methods Subjects were randomly divided into normal group, pre-operative group and post-op- erative group. Anorectal functions were evaluated and the results were analyzed by the multiple comparison procedure. Results Compared with normal group, both the anal canal pressure and the anal canal systolic pressure increased in pre-operative group （P 〈 0.05 ）. In post-operative group, the functional length of anal canal, anal canal pressure and a- nal canal systolic pressure all decreased （P 〈 0.05） , while the rectal sensitivity increased （P 〈 0.05 ）. Conclusion The increase of anal pressure may be the cause of anal fistula. Operation may impair rectal function due to sphincter in- jury. Anal canal pressure could be used as the indicator to evaluate the anorectal function in anal fistula patients before and after operation.