功能性便秘和便秘型肠易激综合征的结肠运输试验及直肠感觉阈值比较

A study on colonic transit test and ano-manometry in functional constipation and constipation-predominant irritable bowel syndrome

目的 对功能性便秘和便秘型肠易激综合征 (IBS)患者进行肠道转运时间及其肛门直肠运动和直肠容量感觉研究 ,探讨两类疾病的结肠运动方式有何不同。方法 用不透X线标志物测定全结肠通过时间和结肠分段通过时间并计算转运指数。用电子气压泵研究肛门直肠压力、直肠对容量刺激的感觉和直肠顺应性。结果 便秘型IBS的结肠转运时间延长主要在右半结肠。功能性便秘的各个节段结肠均有延长 ,结合转运指数研究 ,发现直肠乙状结肠部位的延长更显著。两种疾病的肛门直肠括约肌静息压、收缩压和松弛压均无明显异常 ,但两者的顺应性和排便阈值均明显增高 ,其中功能性便秘的感觉阈值有增加。结论 IBS便秘型结肠运动紊乱主要在右半结肠 ,功能性便秘的结肠动力改变主要在直肠乙状结肠部为多。说明两者的结肠运动方式改变是不同的 ,对两者的鉴别诊断有帮助。

Objective To investigate rectal visceral perception、 anorectal manometry and colonic transit time in functional constipation and constipation-predominant irritable bowel syndrome (IBS) and to assess their variety of manometric abnormalities. Methods The cases with functional constipation and constipation-predominant IBS were studied in a colonic transit test by radiopaque markers. Rectal visceral perception thresholds, rectal compliance and anorectal manometry were examined in patients with functional constipation or constipation-predominant IBS by electric barastat. Results The colonic transit time in both groups of constipation patients was abnormal. A lot of radiopaque markers remined in right colon when patients with constipation-predominant IBS were examined, as the patients with functional constipation in anorectum. The anorectal resting pressure, squeeze pressure and relaxation pressure were similar in both groups. Rectal compliance and defecation thresholds were much higher than normal, and the rectal visceral perception of functional constipation was also abnormal. Conclusion The motility abnormalities between functional constipation and constipation-predominant IBS occure in the different colonic segments. The results suggested that colonic transit test and anorectal manometry might provide a method in differentiatial diagnosis.