基于高分辨率全结肠测压探讨225例不同亚型便秘患者肠道动力学特征

Study on the intestinal motility characteristics of 225 patients with different subtypes of constipation based on high-resolution colon manometry

目的比较慢传输型便秘(STC)、出口梗阻型便秘(OOC)、STC与OOC混合型和正常传输型便秘(NTC)4种亚型便秘患者的高分辨率全结肠测压(HRCM)结果,探讨不同亚型便秘患者的肠道动力学特征。方法回顾性分析2017年1月20日至2020年9月20日于天津市人民医院肛肠外科就诊的225例功能性便秘患者的HRCM结果,根据结肠传输试验结果将225例患者分为STC组(108例)、OOC组(36例)、STC与OOC混合型(混合型组,28例)和NTC组(53例)。比较4组患者的便秘Wexner评分等一般资料,临床症状(便意减退、肛门直肠堵塞感、需手助排便、自发排便频率<3次/周),以及高幅蠕动收缩波(HAPC)的发生率、1 d内发生次数(以下简称频率)、平均速度、平均波幅、平均持续收缩时间、平均收缩长度、平均压力的动力指数和低幅蠕动收缩波(LAPC)的频率、平均波幅、平均持续收缩时间、平均压力的动力指数。统计学方法采用单因素方差分析、Kruskal-Wallis检验和卡方检验。结果STC、OOC、混合型和NTC组的便秘Wexner评分分别为(13.17±4.04)、(13.97±4.55)、(11.36±4.03)和(11.58±4.06)分,差异有统计学意义(F=3.879,P=0.010);STC、OOC组的Wexner评分均高于混合型、NTC组,差异均有统计学意义(单因素方差分析多重比较,P均<0.05)。STC、OOC、混合型和NTC组患者的便意减退、肛门直肠堵塞感、需手助排便和自发排便频率<3次/周占比分别为47.2%(51/108)、36.1%(13/36)、14.3%(4/28)、20.8%(11/53),42.6%(46/108)、75.0%(27/36)、46.4%(13/28)、64.2%(34/53),31.5%(34/108)、38.9%(14/36)、3.6%(1/28)、18.9%(10/53),90.7%(98/108)、77.8%(28/36)、82.1%(23/28)、62.3%(33/53),差异均有统计学意义(χ^(2)=17.093、12.463、13.437、18.927,P均<0.01)。STC组患者的便意减退占比高于混合型和NTC组,自发排便频率<3次/周占比高于OOC和NTC组,差异均有统计学意义(χ^(2)=10.014、10.518、4.418、19.016,P均<0.05)。OOC组患者的肛门直肠堵塞感占比高于STC和混合型组,需手助排便占比高于混合型和NTC组,差异均有统计学意义(χ^(2)=9.511、5.486、10.948、4.363,P均<0.05)。STC、OOC、混合型和NTC组患者中,HAPC的发生率分别为39.8%(43/108)、36.1%(13/36)、57.1%(16/28)和60.4%(32/53),差异有统计学意义(χ^(2)=8.880,P=0.031)。STC组和OOC组的HAPC发生率均低于NTC组,差异有统计学意义(χ^(2)=6.041、5.050,P=0.014、0.025)。4组发生HAPC的患者间的HAPC频率、平均速度、平均波幅、平均持续收缩时间、平均收缩长度、平均压力的动力指数,以及4组患者间的LAPC频率、平均波幅、平均持续收缩时间和平均压力的动力指数比较差异均无统计学意义(P均>0.05)。结论医师能通过HRCM更清晰、直观地观察不同亚型便秘患者的肠道动力学特征。HRCM为功能性便秘的诊断和进一步治疗提供有力依据,具有较高的临床应用价值。

Objective To compare the results of high-resolution colonic manometry(HRCM)in patients with four subtypes of constipation:slow transit constipation(STC),outlet obstruction constipation(OOC),mixed STC and OOC,and normal transit constipation(NTC),and to explore the intestinal motility characteristics of patients with different subtypes of constipation.Methods From 20th January 2017 to 20th September 2020,the HRCM results of 225 patients with functional constipation who visited the Department of Anorectal Surgery of Tianjin Union Medical Center were retrospectively analyzed.According to the results of colonic transit test,225 patients were divided into STC group(108 cases),OOC group(36 cases),mixed group(28 cases)and NTC group(53 cases).General information such as Wexner constipation scores,clinical symptoms(decreased desire to defecate,sensation of anorectal blockage,hand-assisted defecation,spontaneous bowel movements frequency<3 times per week),the incidence,frequency within one day(hereinafter referred to as frequency),average velocity,average wave amplitude,average duration of contraction,average length of contraction,and the dynamic index(DI)of average pressure of high-amplitude propagating contraction(HAPC),as well as the frequency,average wave amplitude,average duration of contraction,and the DI of average pressure of low-amplitude propagating contraction(LAPC)were compared among the four groups.One-way ANOVA and multiple comparison,Kruskal-Wallis test and chi-square test were used for statistical analysis.Results The Wexner constipation scores of the STC,OOC,mixed and NTC group were 13.17±4.04,13.97±4.55,11.36±4.03 and 11.58±4.06,respectively,and the difference was statistically significant(F=3.879,P<0.05).The Wexner consipation scores of the STC and OOC group were both higher than the mixed and NTC group,and the difference were statistically significant(One-way ANOVA and multiple comparison,all P<0.05).The proportion of decreased desire to defecate,sensation of anorectal blockage,hand-assisted defecation,spontaneous bowel movements frequency<3 times per week of STC,OOC,mixed and NTC group were 47.2%(51/108),36.1%(13/36),14.3%(4/28),20.8%(11/53);42.6%(46/108),75.0%(27/36),46.4%(13/28),64.2%(34/53);31.5%(34/108),38.9%(14/36),3.6%(1/28),18.9%(10/53);90.7%(98/108),77.8%(28/36),82.1%(23/28)and 62.3%(33/53),and the differences were statistically significant(χ^(2)=17.093,12.463,13.437 and 18.927;all P<0.01).The proportion of decreased desire to defecate of STC group was higher than that of mixed and NTC group,and spontaneous bowel movements frequency<3 times per week was higher than that of OOC and NTC group,and the differences were statistically significant(χ^(2)=10.014,10.518,4.418 and 19.016;all P<0.05).The proportion of sensation of anorectal blockage of OOC group was higher than that of STC and mixed group,and the proportion of hand-assisted defecation was higher than that of the mixed and NTC group,and the differences were statistically significant(χ^(2)=9.511,5.486,10.948 and 4.363,all P<0.05).The incidence of HAPC in STC,OOC,mixed and NTC groups was 39.8%(43/108),36.1%(13/36),57.1%(16/28),and 60.4%(32/53),respectively,and the difference was statistically significant(χ^(2)=8.880,P=0.031).The incidence of HAPC in STC group and OOC group were lower than that of NTC group,and the differences were statistically significant(χ^(2)=6.041 and 5.050,P=0.014 and 0.025).There were no statistically significant difference in the frequency,average velocity,average amplitude,average duration of contraction,average length of contraction and DI of pressure of HAPC in four groups,and there were no statistically significant difference in the frequency,average amplitude,average duration of contraction,and DI of pressure of LAPC in the four groups(all P>0.05).Conclusions Doctors can more clearly and objectively observe the intestinal motility characteristics of patients with different subtypes of constipation through HRCM.HRCM provides a strong basis for the diagnosis and further treatment of functional constipation,and has a high clinical application value.