功能性便秘患者肛管直肠的动力学研究

The study on Anorectal Motility in Patients with Functional Constipation

目的 研究功能性便秘患者肛管直肠的动力学改变。方法 对22例非老年 (<60岁 )、10例老年(>60岁 )功能性便秘者使用低顺应性水灌注式测压系统 ,采用静止测压法进行肛管直肠测压 ,并分别与健康者作对照。结果 便秘组非老年直肠静息压、肛管静息压、肛管缩榨压及出现肛管直肠抑制反射需最小空气量与对照组非老年比较无显著性差异 (均P>0.05) ,直肠初始感觉阈值和直肠最大耐受量与对照组非老年比较有显著性差异 (P<0.01和<0.05)。便秘组老年直肠静息压和肛管缩榨压与对照组老年比较无显著性差异 (均P>0.05) ,而肛管静息压与对照组老年比较有显著性差异 (P<0.05) ,出现肛管直肠抑制反射所需最小空气量、直肠初始感觉阈值和直肠最大耐受量与对照组老年比较均有显著性差异 (均P<0.05)。结论 功能性便秘患者发病可能与直肠的低敏感及高耐受感觉有关 。

Objective To study anorectal motility in patients with functional constipation(FC). Methods Anorectal pressures were measured with manometry system (CTD-synectics corporation, Sweden) in 22 FC patients aged ≥60 (elderly group) and 10 patients aged < 60 (younger group). Anorectal pressuers in 20 healthy volunteers≥60 and 10 healthy volunteers <60 were also studied as controls. Results There were no significant differences in rectal resting pressure, anal resting pressure, maximum squeeze pressure and minimum relaxation volume to elicit rectal anal inhibitory reflex (RAIR) between younger FC patients and younger control group (P>0.05). The rectal primary sensitivity and maximum tolerance in younger FC patients were significantly higher than those in younger volunteers (P<0.01,P<0.05 respectively). There were no significant differences in rectal resting pressure and maximum squeeze pressure between elderly FC patients and elderly healthy volunteers (P>0.05); however, anal resting pressure, minimum relaxation volume to elicit RAIR, rectal primary sensitivity and maximum tolerance were all significantly higher in elderly FC patients than those in elderly controls (P<0.05).Conclusion The constipation in younger patients may be related to rectal lower sensitivity and higher tolerance. Functional constipation in elderly patients may be also related to low sensitivity and higher tolerance,as well as the fact that internal anal sphincter (IAS) could not relax in time to expanding of rectum.