功能性便秘患者结肠传输试验结果及肛直肠测压参数的关系

Relation between colonic transit test results and anorectal manometry parameters in patients with functional constipation

目的探讨功能性便秘患者中结肠传输试验结果和肛直肠测压参数的关系。方法纳入40例功能性便秘患者,采用胃肠动力标记物胶囊进行结肠传输试验,分别于服用胶囊后48 h和72 h各拍摄腹部平片1张。根据结肠传输试验标记物的残留数量将患者分为完全排空组、残留数1~5组、残留数≥6组;根据结肠传输试验结直肠内标记物的残留部位并结合结肠传输指数,将患者分为完全排空组、结肠型组和直乙型组。同时行固态高分辨率肛直肠测压,记录直肠及肛管静息压、模拟排便时直肠收缩压和肛管残余压,以及直肠对不同容量刺激的感觉阈值。比较结肠传输试验48 h和72 h时上述各组(分别按结直肠传输试验标记物残留数量、残留部位分组)肛直肠测压参数的差异,以及结直肠传输试验标记物残留数量、残留部位与肛直肠测压参数的关系。结果不同结直肠传输试验标记物残留数量组间相比,48 h时完全排空组肛管内静息压(相对直肠)高于残余数1~5组;72 h时完全排空组、残留数1~5组、残留数≥6组模拟排便压力梯度依次减小(负值越大)(均P<0.05),相关分析显示其与结直肠标记物残留数量呈负相关(P<0.05)。不同结直肠传输试验标记物残留部位组间相比,48 h时患者的直肠排便感觉阈值、排便急迫阈值及最大耐受量差异均有统计学意义(均P<0.05),相关分析显示上述三个指标与结直肠标记物残留部位相关(均P<0.05);72 h时结肠型组患者的模拟排便压力梯度负值大于直乙型组和完全排空组(P<0.05),相关性分析显示其与结直肠标记物残留部位相关(P<0.05)。结论功能性便秘患者结肠传输试验结果和肛直肠测压参数存在一定的相关性,结肠传输试验中标记物的残留情况受排便时肛直肠压力差及直肠感觉功能的影响,但两者并不能完全相互替代,故建议对便秘患者同时完善肛直肠测压及胃肠传输试验,从而对便秘的病理生理特点进行全面评估。

Objective To investigate the relation between colonic transit test results and anorectal manometry parameters in patients with functional constipation.Methods Forty patients with functional constipation were included and underwent colonic transit test using gastrointestinal motility marker capsules,then abdominal plain films were obtained 48 and 72 hours after taking the capsules.The patients were divided into complete emptying group,1-5 residuals group and residuals≥6 group according to the number of colorectal residual markers of colonic transit test;and the patients were allocated to complete emptying group,colonic type group or anorectal type group according to the colorectal residual markers distribution of colonic transit test and colonic transit index.In addition,the patients received solid-state high-resolution anorectal manometry,and rectal and anal resting pressures,rectal systolic pressure and anal residual pressure during simulated defecation,and rectal sensory thresholds for different volume stimulation were recorded.At 48 and 72 hours of colonic transit test,a comparison was conducted on the parameters of anorectal manometry among the aforementioned groups with different number of colorectal residual markers of colonic transit test,or among the aforementioned groups with different distribution of colorectal residual markers of colonic transit test,and on the relation of the number or distribution of colorectal residual markers of colonic transit test with the parameters of anorectal manometry.Results The comparison among the groups with different number of colorectal residual markers of colonic transit test revealed that at 48 hours of the test,the complete emptying group yielded higher endoanal resting pressure(relative to rectal value)than the 1-5 residuals group;at 72 hours of the test,anorectal pressure gradient during simulated defecation decreased in the order of the complete emptying group,the 1-5 residuals group and the residuals≥6 group,presenting increasing absolute value(all P<0.05),correlation analysis suggested that anorectal pressure gradient negatively correlated with the number of colorectal residual markers(P<0.05).The comparison among the groups with different distribution of colorectal residual markers of colonic transit test revealed that at 48 hours of the test,the rectal threshold of desire to defecate,threshold of urgency to defecate,and maximum tolerance of the patients showed statistically significant differences(all P<0.05),correlation analysis suggested that the three indicators described above correlated with the distribution of colorectal residual markers(all P<0.05);at 72 hours of the test,the colonic type group exhibited increased absolute value of anorectal pressure gradient during simulated defecation than the anorectal type group or complete emptying group(P<0.05),correlation analysis suggested that the value correlated with the distribution of colorectal residual markers(P<0.05).Conclusion There is a certain correlation between the results of colonic transit test and the parameters of anorectal manometry among patients with functional constipation,and the residual of markers in colonic transit test is affected by anorectal pressure gradient and rectal sensory function during defecation.However,the two tests can not be completely substituted for each other,thus it is suggested that anorectal manometry and gastrointestinal transit test are performed simultaneously on patients with constipation,so as to comprehensively evaluate the pathophysiological characteristics of constipation.