高分辨肛门直肠测压在出口梗阻型便秘生物反馈治疗应用

The clinical value of high-resolution anorectal manometry on functional outlet obstruction constipation by biofeedback therapy

目的评价高分辨肛门直肠测压在接受生物反馈治疗(BF)的出口梗阻型便秘(OOC)患者临床应用价值。方法选择诊断为OOC且接受BF治疗的77例患者,均在BF治疗前后予以高分辨肛门直肠测压,记录并比较参数。分别应用临床症状评分及高分辨肛门直肠测压评估BF治疗疗效,并比较两种方法的差异。应用Logistic回归分析评估肛门直肠测压参数与生物反馈治疗有效率的相关性。结果 OOC患者BF治疗后直肠感觉阈值、直肠最大耐受量均较治疗前减少(P<0.05),但肛管静息压、肛管最大收缩压无显著差异(P>0.05)。临床症状评分评估患者治疗后有效率为76.62%,高分辨肛门直肠测压评估有效率为77.92%,两者差异无显著性(P=0.078)。以临床症状评分标准为金标准,高分辨率肛门直肠测压的敏感度为94.92%,特异度为77.78%,准确度为90.91%。多元Logistic回归分析显示,肛管最大收缩压、直肠感觉阈值是生物反馈治疗有效率的独立预测因子(P<0.05)。结论高分辨肛门直肠测压能有效反映OOC患者的肛门直肠动力学异常,评估接受BF治疗后的临床疗效。

Objective To evaluate the clinical value of high-resolution anorectal manometry （ARM） on functional outlet obstruction constipation （OOC） by biofeedback （BF） therapy. Methods A total of 77 patients with OOC who received the therapy of BF were collected.All patients received the high-resolution ARM at pre- and post-BF therapy respectively.The indexes of high-resolution ARM were recorded and compared between pre- and post-BF therapy.The clinical effect of the BF therapy were evaluated and compared by clinical symptom score and the high-resolution ARM respectively.The relationship of the indexes of high-resolution ARM and the effective rate of BF therapy were evaluated by multivariate Logistic regression analysis. Results The indexes of RST and RMT post-therapy of the patients with OOC were lower than pretherapy （P〈0.05） ,but the RAP and AM CP were no different （P〉0.05）.The effective rate of the clinical symptom score and the high-resolution ARM to the patients with OOC was 76.62% and 77.92% respectively. Using the clinical symptom score as the standard, the sensitivity of high-resolution ARM was 94.92% ,the specificity was 77.78% and the accuracy was 90.91%.The clinical effects were no different between two methods at post-therapy.The values of AMCP and RST were the independent risk factor to the effective rate of biofeedback therapy by muhivariate Logistic regression analysis （ P〈0.05 ）. Conclusion The high-resolution ARM can effectively reflect the degree of abnormal anoreetal dynamics and evaluate the clinical effect of patients with OOC by biofeedback therapy.