直肠前突患者的直肠肛门测压特点分析

Features of anorectal manometry in patients with reetocele

目的 了解直肠前突患者的肛门、盆底功能，并对直肠前突的治疗提供依据。方法 顺序纳入功能性便秘（FC）患者及健康对照者，所有受试者完成排粪造影、直肠肛门测压。根据排粪造影所示的直肠前突程度将受试者分入无、轻度、中度及重度直肠前突组。通过t检验、方差分析、秩和检验，以及卡方检验等统计学方法，比较FC患者中不同程度直肠前突者的直肠肛门测压结果。并比较伴中度直肠前突的FC组与伴中度直肠前突的对照组的测压结果。结果 共纳入FC患者54例，健康对照者17名。所有男性受试者均未发现直肠前突。48例女性FC患者中，9例（18．8％）无直肠前突，7例（14．6％）为轻度，18例（37．5％）为中度，14例（29．2％）为重度直肠前突。12名女性对照者中，3名无直肠前突，1名轻度直肠前突，8名中度直肠前突，无重度直肠前突。在女性FC患者中，重度直肠前突组直肠力排压[（34．4±14．2）mmHg，1 mmHg=0．133 kPa]显著高于无直肠前突组[（20．8±13．1）mmHg，f=3．663，P=0．001]、轻度直肠前突组[（19．1±15．1）mmHg，t=3．719，P〈0．01]和中度直肠前突组E（25．6±16．3）mmHg，t=2．525，P=0．010]。轻度直肠前突组肛管力排剩余压[（55．1±19．7）mmHg]显著高于中度直肠前突组[（43．3±17．6）mmHg，t=2．507，P=0．019]、重度直肠前突组[（40．0±20．9）mmHg，t=2．619，P=0．006]。轻度直肠前突组肛管松弛率[3．0％（0．5％，25．5％）]显著低于中度直肠前突组[19．5％（10．0％，29．0％），Z=-2．583，P=0．OlO]和重度直肠前突组[22．0％（7．3％，54．5％），z=-2．830，P=0．005]；4组间直肠和肛管静息压、肛管最大缩榨压、直肠感觉阈值及测压分型构成比差异均无统计学意义（P均〉0．05）。伴中度直肠前突的FC患者肛管力排剩余压显著高于伴中度直肠前突的对照者[（43．3±17．6）mmHg比（26．3±20．8）mmHg，t=2．997，P〈0．01]，肛管松弛率则低于伴中度直肠前突的对照者[（23．4±20．2）％比（55．2±16．3）％，t=-5．266，P=0．008]。结论直肠前突多见于女性，并可见于排便正常者。FC患者中，轻度直肠前突者表现为排便时肛管松弛不充分；而重度直肠前突者排便相对协调，可能是盆底松弛的局部表现。

Objective To assess the anal and pelvic floor function in patients with rectocele （RC）,and to afford the evidence for the treatments of RC. Methods Patients with functional constipation （FC）and healthy controls were consecutively enrolled, and all the subjects underwent defecography andanorectal manometry. According to defecography, the subjects were divided into four groups as no RC,mild RC, moderate RC and severe RC. The t-test, analysis of variance, rank sum test and Chi-square testwere performed to compare the results of anorectal manometry between different RC groups in FCpatients, and the results of anorectal manometry between moderate RC group in FC patients and controlgroup with moderate RC were also compared. Results A total of 54 FC patients and 17 healthy controlswere enrolled. No RC was found in all of male subjects. Of 48 female patients with FC, nine cases（18.8%） had no RC, seven （14.6%） had mild RC, 18（37.5%） had moderate RC, and 14（29.2%） hadsevere RC. Three of the 12 female controls had no RC, one had mild RC, and eight had severe RC.Among all female patients with FC, the defecation rectal pressure in severe RC group （（34. 4± 14.2） mmHg. 1 mmHg = 0. 133 kPa） was significantly higher than of no RC group （（20. 8 4± 13. 1） mmHg. t=3.663, P=0.001）, mild RC group （（19.1±15. 1） mmHg, t=3.719, P=0.01） and moderate RC group （（25. 6± 16. 3） mmHg, t=2. 525, P=0. 010）. The left rectal pressure after defecation in mild Rc group （（55. 1 ±19.7） mmHg） was significantly higher than that of moderate RC group （（13.3±17.6）mmHg. t=2. 507, P=0.019） and severe RC group （（40.0±20.9） mmHg, t= 2. 619. P--0.006）. The anal relax ratio in mild RC group （3.0%, 0.5% to 25.5%） was significantly lower than that of moderate RC group （19.5%, 10.0% to 29.0%, Z=-2.583, P=0.010） and severe RC group （22.0%;, 7.30% to 54.5%, Z= -2. 830, P=0. 005）. There were no significant differences in rectal and anal resting pressure, anal squeezing pressure, rectal sensory threshold and constituent ratio of manometry among four groups （all P〉0.05）. The left rectal pressure after defecation in FC patients with moderate RC （（43.3 ± 17. 6） mmHg） was significantly higher than that of controls with moderate RC （（26.3±20.8） mmHg, t= 2. 997, P%0.01 ）, and anal relax ratio was significantly lower than that of controlswih moderate RC （（23. 1±20.2）± vs （55.2±16.3）±, t=-5.266, P=0.008）. Conclusions RC is found in female and also found in individuals with normal defecation. FC patients with mild RC lack enough anal relax during defecation. However, defecation is relatively coordinate in FC patients with severe RC, which indicates that severe RC may be part of manifestation of pelvic floor relaxation.