肛门直肠压力监测对肛瘘术后肛门括约肌功能障碍的诊断价值

Anorectal manometry for the diagnosis of anal sphincter dysfunction in anorectal fistula

目的肛门括约肌功能障碍是肛瘘术后的并发症之一。B超及MRI检查可对肛门括约肌功能障碍的形态学诊断提供一定依据,但不能获得括约肌功能障碍的确切依据。肛门直肠压力监测是研究肛门直肠生理、诊断肛肠疾病和评价肛肠疾病手术效果的重要方法。通过研究直肠肛门瘘手术前后肛肠压力学的改变,可对肛门失禁严重程度进行评估,分析排便失禁原因,了解肛瘘手术后肛门括约肌功能障碍和术后恢复情况,指导手术方式。方法对138例肛瘘患者进行肛门直肠压力监测,对其中14例排便失禁患者进行失禁严重性分级评分,对比分析手术前后高位、低位肛瘘患者及正常人的各项测压指标。结果高位肛瘘手术前和手术后肛门直肠反射敏感率分别低于低位肛瘘手术前和手术后组,而低位肛瘘手术前和手术后反射敏感率均低于健康人对照组(P<0.05)。高位肛瘘手术前和手术后组直肠静息压、肛管静息压和肛管收缩压分别低于低位肛瘘手术前和手术后组。低位肛瘘手术前和手术后3项指标均低于健康人对照组(P<0.05),高位和低位肛瘘3项指标手术后均低于手术前。手术后138例患者中有14例出现不同程度的肛门失禁,其中9例高位肛瘘患者肛门功能B级5例,C级2例,D级2例,5例低位肛瘘患者均为B级。所有排便失禁患者肛肠压力检测结果与排便失禁严重性分度评分情况基本相符。结论肛门直肠压力监测为肛瘘手术后肛门括约肌功能障碍的诊断性评估提供重要的客观依据,对肛瘘的临床治疗具有重要的指导意义。

Objective Anal sphincter dysfunction is one of the postoperative complications of anorectal fistula. Uhrasonography and MRI may give some morphological help, but cannot provide exact evidence for its diagnosis. Anorectal manometry plays an important role in the study of the physiology, diagnosis and evaluation of the surgical results of anorectal diseases. The purpose of this study is to find a better method for anal fistula surgery by assessing the severity of fecal incontinence, analyzing its causes, and looking into the postoperative recovery of anorectal sphincter function. Methods A total of 138 anorectal fistula patients received anorectal manometry, and 14 of them were graded by their fecal incontinence severity indexes. Then comparative analyses were made on the pre-and post-operative manometric indexes between the patients and normal healthy subjects. Results Anorectal reflex sensitivity was lower in the high fistula than in the low fistula patients before and after surgery, and so was it in the low fistula patients than in the normal healthy subjects （P 〉0. 05 ）. Rectal resting pressure, anal resting pressure and anal squeeze pressure were obviously lower in the high than in the low fistula group before and after surgery, and so were they in the low fistula patients than in the normal controls （P 〉 0.05）. The above three indexes were lower postoperatively than preoperatively in both the high and low fistula groups. Fecal incontinence occurred in 14 of the cases after surgery, of which 9 cases were high fistula （grade B anal function in 5 cases, grade C in 2, and grade D in the other 2）, and the other 5 were low fistula （ grade B）. All the manometric results of fecal incontinence accorded with the se- verity indexes. Conclusion Anorectal manometry provides a useful objective tool for evaluating anal sphincter function before and after anal fistula surgery, which is of guiding significance for the surgical management of anorectal fistula.