球囊逼出试验与肛门直肠测压在出口梗阻型便秘诊断中的一致性分析

目的探讨不同类型慢性功能性便秘排便动力学特点及球囊逼出试验在诊断出口梗阻型便秘方面与肛门直肠测压的一致性。方法选择2016年1月至12月符合罗马Ⅲ功能性便秘诊断标准的患者146例，分为出口梗阻型便秘（OCC）组和非出口梗阻型便秘（非OCC）组，先后进行球囊逼出试验及肛门直肠测压，采用t检验对两组肛门测压结果数据进行比较分析，并比较球囊逼出试验与直肠测压结果的一致性。结果（1）直肠动力学情况：OCC组肛门括约肌最大收缩压显著高于非OCC组（P〈005）。模拟排便时，OCC组肛门松弛率及残余压与非OCC组比较，差异有统计学意义（P〈0.05）。（2）直肠感觉参数：OCC组初始便意容量、强烈便意容量及最大耐受容量比非OCC组均有所增高，强烈便意容量及最大耐受容量差异有统计学意义（P〈0.05）。（3）球囊逼出试验在诊断出口梗阻型便秘敏感性为0．882，特异性为0．343，阳性预测值为0.593，阴性预测值为0．727，与肛门直肠测压一致性为0．623。结论OCC和非OCC患者直肠动力学存在差异；球囊逼出试验在出口梗阻型便秘诊断上与肛门直肠测压一致性欠佳，可作为诊断的初步筛查。

Objective To explore the dynamic characteristics of different types of chronic constipation and the agreement between balloon expulsion test and anorectal manometry in the diagnosis of outlet obstruction constipation. Methods From January to December in 2016, patients who fulfilled the ROME Ⅲ criteria for functional constipation were enrolled in this study. They were divided into export obstructive constipation （ OCC ） and non-export obstructive constipation （ Non-OCC ） , the balloon extubation test and anorectal manometry were performed. The t-test was used to test whether there were any differences in data of anorectal manometry between the two groups, and the agreement between balloon expulsion test and anorectal manometry. Results （ 1 ） Rectal dynamics： The maximum anal systolic pressure in OCC group was significantly higher than that in non- OCC group （P〈0.05） . At the time of simulated defecation, the anal relaxation rate and residual pressure of OCC group were statistically significant （ P〈0.05 ） . （ 2 ） The rectal sensory parameters： the initial capaciW of the OCC group, the strong capacity and the maximum tolerated capacity were higher than those of the non-OCC group, and the urinary capacity and the maximum tolerated capacity were statistically significant （ P〈0.05 ） . （ 3 ） In diagnosing of OCC, the sensitivity of balloon expulsion test was 0.882, specificity was 0.343, positive predictive value was 0.593, negative predictive value was 0.727, and consistency was 0.623. Conclusion There is a difference in rectal kinetics between OCC and non-OCC patients. Balloon expulsion test is poorly consistent with anorectal manometry in the diagnosis of OCC, and can be used as an initial screening for diagnosis.