高分辨率全结肠测压对肌源性慢传输型便秘患者肠道动力特征的诊断价值探讨

Diagnostic accuracy of high-resolution colon manometry for characterizing intesti⁃nal mobility in patients with myogenic slow transit constipation

目的探讨高分辨率全结肠测压检查对肌源性慢传输型便秘(STC)患者肠道动力特征的诊断价值。方法纳入2016年12月至2020年4月天津市人民医院收治的32例肌源性STC患者和肛肠外科门诊招募的32例健康志愿者为研究对象,记录肌源性STC患者的临床症状及Cleveland便秘评分(CCS),对所有研究对象行高分辨率全结肠测压检查,观察高幅蠕动收缩波(HAPCs)、低幅蠕动收缩波(LAPCs)、胃结肠反射、晨起结肠反射的相关表现,记录HAPCs的检出情况及其形态。结果肌源性STC患者存在一种或多种便秘症状,CCS便秘评分为(14.2±4.2)分。与健康志愿者相比,肌源性STC患者HAPCs的数量更少,波幅更低,收缩长度更短,曲线下面积更小(均P<0.05),两者之间HAPCs的速度、持续收缩时间及LAPCs的数量比较差异均无统计学意义(均P>0.05)。87.5%(28/32)的肌源性STC患者及所有健康志愿者都存在胃结肠反射,肌源性STC患者午餐后90 min、晨起的HAPCs数量均少于健康志愿者(均P<0.05)。健康志愿者检出HAPCs总数为452个,肌源性STC患者相应为127个;健康志愿者和肌源性STC患者均可检出Ⅰ~Ⅳ型的HAPCs,Ⅴ型HAPCs仅见于肌源性STC患者。结论高分辨率全结肠测压检查可定量分析肌源性STC的肠道动力特征,为慢性便秘的诊断和治疗提供可靠依据,具有良好的临床应用价值。

Objectives To determine the diagnostic accuracy of high-resolution colon manometry for characterizing intestinal mo⁃bility in patients with myogenic slow transit constipation(STC).Methods Thirty-two patients with myogenic STC treated at the Tianjin Union Medical Center between December 2016 and April 2020 were recruited.Thirty-two healthy participants were re⁃cruited from the Department of Colorectal Surgery outpatient clinic as the healthy controls.Symptoms of the myogenic STC and Cleveland constipation scale(CCS)score were recorded for the patients.All participants,including patients and healthy controls,received high-resolution colon manometry.High amplitude propagated contractions(HAPCs),low amplitude propagated contrac⁃tions(LAPCs),gastro-colic reflex,colic reflex after waking up in the morning were recorded.The presence and features of HAPCs were recorded.Results Patients with myogenic STC showed one or more symptoms of constipation,and the mean(SD)score of CCS for the patients was 14.2(4.2).Compared with healthy controls,patients with myogenic STC had significantly fewer HAPCs,lower amplitude of HAPCs,shorter contraction length of HAPCs,and smaller area under the curve of HAPCs(P<0.05).The two groups did not differ significantly in the speed and continuous contraction time of HAPCs,and the number of LAPCs(P>0.05).Gastro-colic reflex was found in 87.5%(28/32)of the patients with myogenic STC and all healthy controls.The HAPCs at 90 minutes after lunch and waking up in the morning were significantly less in patients with myogenic STC(P<0.05).The to⁃tal number of HAPCs was 452 in healthy controls and 127 in patients with myogenic STC.TypeⅠtoⅣHAPCs were found in healthy controls and patients,but typeⅤHAPC was only found in patients with myogenic STC.Conclusion High-resolution colon manometry can quantify intestinal mobility in patients with myogenic STC.It serves as a reliable tool for diagnosing and treating chronic constipation.It has excellent value for clinical application.