老年功能性排便障碍患者肛门直肠动力的特点

Characteristics of anorectal motility in elderly patients with functional defecation disorders

目的探讨老年功能性排便障碍患者肛门直肠动力学的特点,为其诊断、治疗及预防提供依据。方法回顾性分析226例行3D高分辨肛门直肠测压的功能性排便障碍患者,分为老年组(93例)与非老年组(133例),对比两组患者肛门直肠测压相关参数,同时分析老年组在不同性别、Bristol分型、临床症状等方面肛门直肠压力变化的特点。结果老年组的肛管静息压、直肠压力、肛门松弛率较非老年组降低(t=-3.407、-2.051、Z=2.548,P=0.001、0.040、0.011);初始感觉容量较非老年组升高(t=1.998、P=0.047)。老年男性肛管最大收缩压、肛门残余压、最大耐受容量较老年女性更高(t=4.589、4.730、2.025,均P<0.05);肛门松弛率、直肠肛管压力差较老年女性更低(Z=4.059、t=-3.714,均P<0.001);在排便障碍分型比较中,老年组和非老年组均以Ⅱ型排便障碍为主,其中老年组中男性多于女性(χ^(2)=10.343,P=0.001)。模拟排便时的肛门括约肌矛盾运动比较,老年组肛门括约肌反常收缩发生率为80.65%(75/93),高于非老年组68.42%(91/133)(χ^(2)=4.194、P=0.041)。老年组中无便意患者的初始感觉容量、初始排便感觉容量、最大耐受容量分别为(59.86±23.84)ml、(96.76±34.61)ml、(144.32±30.57)ml,均高于有便意患者(46.79±17.20)ml、(75.26±28.75)ml、(120.00±40.28)ml(t=-2.241、-2.493、-2.891,P=0.027、0.014、0.005),有排便费力患者的直肠压力(26.52±16.08)mmHg、低于无排便费力患者(39.91±8.82)mmHg(1 mmHg=0.133 kPa)(t=-3.128,P=0.002)、肛管静息压(90.60±28.44)mmHg,高于无排便费力患者(73.65±27.10)mmHg(t=-2.201,P=0.030),有肛门堵塞感患者肛管静息压、肛管最大收缩压压(87.11±24.64)mmHg、(149.28±48.29)mmHg高于无肛门堵塞感患者(72.43±20.02)mmHg、(121.76±26.35)mmHg(t=2.954、3.066,P=0.004、0.003)。不同Bristol分型及有无排便不尽感、腹胀患者的肛门直肠动力学指标比较,差异均无统计学意义(均P>0.05)。结论FDD患者肛门直肠动力学特点均存在肛门括约肌矛盾运动,但老年FDD患者主要为直肠推进力不足,盆底肌功能失调、直肠敏感性降低。

Objective To investigate the characteristics of anorectal dynamics in elderly patients with functional defecation disorders(FDD),and to provide a basis for their diagnosis,treatment and prevention.MethodsIn this retrospective study,226 patients with FDD receiving 3D high-resolution anorectal manometry were divided into an elderly group(93 cases)and a non-elderly group(133 cases).Results from anorectal manometry parameters were compared and analysis of patterns of anorectal pressure changes in elderly participants based on sex,the Bristol stool classification and clinical symptoms was conducted.ResultsThe resting anal pressure,rectal pressure and anal relaxation rate were lower(t=-3.407,-2.051,Z=2.548,P=0.001,0.040,0.011)and the volume of first sensation was higher(t=1.998,P=0.047)in the elderly group than in the non-elderly group.The maximum anal squeezing pressure,residual anal pressure and maximum tolerated volume were higher(t=4.589,4.730,2.025,all P<0.05),whereas the anal relaxation rate and anorectal pressure gradient were lower in elderly men than in elderly women(Z=4.059,t=-3.714,P<0.001 for both).Regarding the types of FDD,both the elderly group and the non-elderly group were dominated with typeⅡdefecation disorder,with more men than women having typeⅡdefecation disorder in the elderly group(χ^(2)=10.343,P=0.001).In cases of paradoxical sphincter contraction during simulated defecation,the incidence in the elderly group was 80.65%(75/93),which was higher than 68.42%(91/133)in the non-elderly group(χ^(2)=4.194,P=0.041).The volume of first sensation,volume of first defecation sensation,and maximum tolerated volume of patients in the elderly group without the urge to defecate were(59.86±23.84)ml,(96.76±34.61)ml,and(144.32±30.57)ml,respectively,higher than those of patients with the urge to defecate(46.79±17.20)ml,(75.26±28.75)ml,and(120.00±40.28)ml(t=-2.241,-2.493,-2.891,P=0.027,0.014,0.005).The rectal pressure(26.52±16.08)mmHg of patients with defecation dyssynergia was lower than that of patients without defecation dyssynergia(39.91±8.82)mmHg(1 mmHg=0.133 kPa)(t=-3.128,P=0.002),while the resting anal pressure of patients with defecation dyssynergia(90.60±28.44)mmHg was higher than that of patients without defecation dyssynergia(73.65±27.10)mmHg(t=-2.201,P=0.030).The resting anal pressure and maximum anal squeezing pressure in patients with anal blockage sensation[(87.11±24.64)mmHg,(149.28±48.29)mmHg]were higher than those in patients without anal blockage sensation[(72.43±20.02)mmHg,(121.76±26.35)mmHg](t=2.954、3.066,P=0.004、0.003).There was no significant difference in values from parameters of anorectal dynamics between patients with different Bristol stool types,with and without incomplete defecation or with different degrees of abdominal distension(all P>0.05).ConclusionsAnorectal dynamics in patients with FDD are characterized by paradoxical anal sphincter movements,but older patients with FDD are mainly characterized by inadequate rectal propulsion,pelvic floor muscle dysfunction and reduced rectal sensitivity.