肛门直肠测压在便秘诊断中的作用

Significance of anorectal manometry in diagnosis of constipation

目的研究不同类型便秘患者的肛门直肠测压表现及肛门直肠测压在便秘诊断中的作用。方法收集我科便秘患者163例,将其分类为结肠慢传输型(slow transit constipation,STC)便秘46例,出口梗阻型(outlet obstructive constipation,OOC)便秘93例,混合型(mixed constipation,MC)便秘24例。正常对照组30例。用肛门直肠测压方法检测各组患者的直肠初始感觉容量、初始便意容量、最大耐受容量以及肛管静息压、收缩压、咳嗽时肛管压和排便时肛管压,分析统计其测压数据并进行比较。结果与对照组相比,便秘组患者直肠初始感觉容量、初始便意容量差异无统计学意义(P>0.05),而最大耐受容量明显增加,差异有统计学意义(P<0.05)。便秘组所有患者肛管静息压、肛管收缩压均明显低于对照组,差异有统计学意义(P<0.05)。STC组患者肛管静息压、肛管收缩压、咳嗽时肛管压及排便时肛管压均明显低于对照组及OOC组,差异均有统计学意义(P<0.05);而OOC型患者排便时肛管压明显增高,差异有统计学意义(P<0.05)。结论不同类型的便秘患者其肛肠测压表现不同,提示便秘患者存在着肛门直肠动力异常和直肠感觉异常。

Objective To investigate the anorectal manometry in different types of constipation and its significance in the diagnosis of the disease.Methods Clinical data of 163 out-and in-patients with constipation in our department from March 2010 to June 2013 were retrospectively collected.They were divided into colonic slow transit constipation group（n=46）,outlet obstruction constipation（n=93）,and mixed constipation（n=24）.Another 30 healthy individuals served as normal control group.Anorectal manometry was carried out in controls and patients with chronic constipation.The rectal first sensation,first defecation sensation,maximum tolerable volume,anal resting pressure,squeeze pressure,coughing pressure and defecation pressure were determined.Results No difference was found in rectal first sensation and first defecation sensation between the patients and normal controls,while maximum tolerable volume was significantly higher in the former than the later group（P0.05）.The anal resting pressure and squeeze pressure of patients with constipation were lower in the patients than controls（P0.05）.The anal resting pressure,squeeze pressure,coughing pressure and defecation pressure were lower of patients with slow transit constipation than in controls and outlet obstructive constipation patients,while the defecation pressure of outlet obstructive constipation patients was increased significantly（P0.05）.Conclusion Patients with different types of constipation have different anorectal manometry,suggesting that constipation patients having abnormalities in anorectal dynamics and sensory function.