慢性便秘的分型和肛门直肠测压表现

Categorization and anorectal manometry in chronic constipation

目的 对慢性便秘按结肠传输时间 (CTT)和传输指数 (TI)进行分型 ,观察便秘及便秘各型肛门直肠动力学和感觉功能的变化。方法 采用一次口服 2 0枚不透X线标记物于 72h拍摄腹平片的方法 ,根据CTT和TI对慢性便秘进行传输分型 ;用肛门直肠测压的方法测定不同类型便秘的肛门直肠动力及感觉功能的变化。结果 慢性便秘的传输分型为四型 :传输时间正常型 (NTC)、慢传输型(STC)、出口梗阻型 (OOC)和混合型 (MC)。便秘组的肛管静息压和收缩压降低 ,最大耐受容积增大 (P<0 .0 5 )。NTC患者肛管静息压降低 (P <0 .0 5 ) ;STC患者静息压、收缩压降低 ,最大耐受容积增大 (P<0 .0 5 ) ;OOC患者最大耐受容积增大 (P <0 .0 5 )。结论 此种传输试验方法更简单 ;根据CTT和TI对便秘进行传输分型可体现便秘的动力学原因 ;不同类型的便秘存在不同的结肠。

Objective We categorized chronic constipation according to colonic transit time (CTT) and transit index (TI), and investigated the abnormalities of anorectal motility and sensory function in patients in different categories. Methods Each subject ingested 20 radiopaque markers, and abdominal X rays were obtained at 72 h. Chronic constipation was categorized according to CTT and TI. Anorectal manometry was carried out in all subjects to investigate the abnormalities of anorectal motility and sensory function in patients in different categories. Results Chronic constipation was divided into four types: normal transit constipation (NTC), slow transit constipation (STC), outlet obstructive constipation (OOC), and mixed type constipation (MC). Patients with constipation displayed significantly lower anorectal resting pressure, squeezing pressure and larger rectal maximum tolerate volume than controls ( P <0.05). Compared with controls, NTC displayed significantly lower anorectal resting pressure ( P <0.05) while STC displayed significantly lower anorectal resting pressure and squeezing pressure ( P <0.05). The rectal maximum tolerate volume in STC and OOC was significantly higher than that of controls ( P <0.05). Conclusion It is a simple method to take abdominal X rays at 72 h after ingesting 20 radiopaque markers. Categorization of constipation according to CTT and TI can be an indicator of the dynamic etiology of constipation. Patients with constipation in different categories had different abnormalities of anorectal dynamics and sensory function.