肛门直肠测压技术与便秘患者排便障碍症状及分型的相关性研究

Correlation between anorectal manomentry techniques and defecation disorders symptoms and classification in patients with constipation

目的分析肛门直肠测压结果与排便障碍症状及分型的相关性,探讨其临床应用价值。方法对202例便秘患者行肛门直肠测压检查,记录各项指标检查结果和排便相关症状。结果便秘患者以中老年人群为主。肛门直肠测压检查异常结果中,以肛管最长收缩时间异常发生率最高,占80.2%(162例)。排便症状中以排便次数减少发生率最高,占47.5%(96例)。腹胀组排便协调障碍W型患者比例高于无腹胀组(P<0.05)。粪便干结组患者肛管最大收缩压不足、排便费力组患者肛管静息压升高、排便不尽感组患者直肠排便阈值降低、肛门梗阻感组患者肛管最长收缩时间延长和直肠静息压升高的发生率分别明显高于相应症状阴性组(P<0.05)。结论排便障碍型便秘最常见,排便费力和肛门梗阻感提示肛管松驰不良,腹胀则与直肠推进力不足及肛管松弛不良有关。此外,排便不尽感与直肠感觉高敏状态有关。细化便秘症状并综合考虑多种影响便秘的因素,同时结合结肠传输试验、排粪造影等检查可为临床提供精准的诊断和个体化治疗方案。

Objective To analyze the correlation between anorectal manometry ( AM ) findings and defecation disorders with symptoms and classification, and explore its value in clinical application. Methods A total of 202 patients with constipation who took the AM examination were enrolled, the AM findings and defecation symptoms were recorded. Results Patients with constipation are mainly middle-aged and elderly. Among the abnormal results of AM, the incidence of anal longest contraction time ( ALCT) was the highest,accounting for 80.1%(162 cases). Among the defecation symptoms, the incidence of defecation was the highest, accounting for 47. 5%( 96 cases). The rate of patients with dyssynergia types IV in abdominal distension group was higher than that of without abdominal distension group ( P<0.05 ). The incidence of insufficient anal maximal contraction pressure in patients with hard stool, increased anal resting pressure in patients with difficulty in defecation, decreased rectal defecation thresholds in patients with feelings of incomplete evacuation, prolonged ALCT of obstruction and increased rectal resting pressure in patients with feelings of anal obstruction were significantly higher than that of negative corresponding symptom group(P <0.05). Conclusion Defecation disorders is most common in constipation. Diffculty in defecation and anal obstruction symptoms seemed to indicate insufficient anal relaxation. Abdominal distension is closely associated with insufficient anal relaxation and poor rectal propulsion. Feeling of incomplete evacuation is closely related to rectoalgesia. Refining the symptoms of constipation and comprehensively considering a variety of factors affecting constipation, combined with colonic transmission test, defecation angiography and other examinations can provide accurate diagnosis and individualized treatment options for the clinic.