摘要
背景功能性便秘(FC)发病率高,病因复杂,已成为影响现代人工作和生活质量的重要因素之一。肛门直肠测压是检测便秘患者肛门直肠功能的重要方法,可了解、量化和评估肛管、直肠排便功能,为治疗方案的选择提供依据并可评估疗效,目前已广泛应用于FC的诊断治疗。目的探讨不同性别、年龄及伴随症状FC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。方法选取2016年6月—2017年12月在西安交通大学第一附属医院胃肠动力室行固态高分辨率直肠肛管测压的FC患者95例为研究对象,均符合罗马Ⅲ功能性便秘的诊断标准。比较不同性别、年龄〔参照20世纪末联合国对年龄划分的新标准(规定60岁及以上为老年人)将研究对象分为老年组和非老年组〕、Bristol分型及伴随症状(排便费力、排便不尽感、腹胀、腹痛)患者肛门直肠动力学〔肛管静息压、高压带宽度、肛管最大缩榨压、最大缩榨压持续时间、直肠感觉阈值(初始感觉容量、排便感觉容量、最强便意容量、最大耐受容量)、直肠压及肛管残余压、压力差、松弛率〕特点。结果男性与女性肛管静息压、最大缩榨压持续时间、肛管残余压、直肠压及松弛率比较,差异有统计学意义(P<0.05);男性与女性高压带宽度、肛管最大缩榨压、初始感觉容量、排便感觉容量、最强便意容量、最大耐受容量、压力差比较,差异无统计学意义(P>0.05)。老年组患者肛管静息压、初始感觉容量、排便感觉容量、最强便意容量、松弛率低于非老年组(P<0.05);老年组和非老年组高压带宽度、肛管最大缩榨压、最大缩榨压持续时间、最大耐受容量、直肠压、肛管残余压、压力差比较,差异无统计学意义(P>0.05)。不同Bristol分型及有无排便费力、排便不尽感患者的肛管静息压、肛管最大缩榨压及直肠感觉阈值比较,差异无统计学意义(P>0.05)。有腹胀、腹痛患者排便感觉容量大于无腹胀、腹痛患者(P<0.05);有无腹胀、腹痛患者肛管静息压、肛管最大缩榨压、初始感觉容量、最强便意容量、最大耐受容量比较,差异无统计学意义(P>0.05)。男性矛盾收缩发生率高于女性,老年组矛盾收缩发生率高于非老年组,排便费力者矛盾收缩发生率高于无排便费力者(P<0.05);不同Bristol分型及有无排便不尽感、腹胀、腹痛患者矛盾收缩发生率比较,差异无统计学意义(P>0.05)。结论女性FC肛门直肠动力学的特点表现为盆底肌功能紊乱和排便推动力不足。老年FC较非老年FC直肠高耐受及盆底肌功能失调更明显,盆底肌功能失调及直肠高耐受是老年FC发病的重要因素。在伴随症状方面,伴有腹胀、腹痛的患者常常伴有排便感觉容量的异常,其排便感觉容量阈值高于对照组,排便感觉敏感性降低。功能性便秘发病率高,病因复杂,严重影响人们的生活和工作。FC与直肠肛管压力和感觉功能异常有关,通过对FC患者肛门直肠动力学特点的分析,可了解、量化和评估肛管、直肠排便功能,有助于探讨功能性便秘的发病机制,为诊断和治疗方案的选择提供依据并可评估疗效。
Background As a disease with complex etiology and high incidence,functional constipation(FC) has become an important health problem affecting the quality of work and life of people.Anorectal manometry is an important technique for detecting anorectal function in patients with constipation.It can identify,quantify and evaluate the function of anal canal and rectum,providing a basis for the selection of treatment option and evaluation of the treatment efficacy.It has been widely used in the diagnosis and treatment of FC.Objective To give an anorectal manometry analysis of patients with FC by sex,age and accompanying symptoms,offering evidence for its prevention,diagnosis,and treatment.Methods We enrolled 95 cases of FC who underwent solid-state high-resolution anorectal manometry from Gastrointestinal Motility Room,the First Affiliated Hospital of Xi'an Jiaotong University during June 2016 to December 2017.All of them were diagnosed according to the Rome Ⅲ diagnostic criteria for FC.We made comparisons between them in terms of sex,age(old people are those who aged 60 or over in accordance with Provisional Guidelines on Standard International Age Classifications),types of stool(assessed by the Bristol Stool Scale) and accompanying symptoms(difficult defecation,incomplete defecation,abdominal distension,abdominal pain),and anorectal manometry parameters〔anal resting pressure,anal canal high-pressure band width,maximum anal squeeze pressure,maximum anal squeeze pressure duration,rectal sensory thresholds(first sensation,desire and urgency to defecate,urgency to defecate,and maximal tolerable volume),rectal pressure and anal residual pressure,anorectal pressure difference,percent anal relaxation〕.Results There were significant differences between males and females in anal canal resting pressure,maximum anal squeeze pressure duration,anal residual pressure,rectal pressure and percent anal relaxation(P<0.05). There were no significant differences between males and females in anal canal high-pressure band width,maximum anal squeeze pressure,first sensation,desire and urgency to defecate,maximal tolerable volume,and anorectal pressure difference (P>0.05).Compared with the elderly group(aged 60 or over),non-elderly group(aged less than 60) had lower anal canal resting pressure,less first sensation,desire and urgency to defecate,percent anal relaxation(P<0.05),but similar anal canal high-pressure band width,maximum anal squeeze pressure,maximum anal squeeze pressure duration,maximal tolerable volume,anal residual pressure,rectal pressure and anorectal pressure difference(P>0.05).Types of stool,difficult defecation and incomplete defecation were not associated with the values of anal resting pressure,maximum anal squeeze pressure and rectal sensory thresholds(P>0.05).Abdominal distension and abdominal pain were associated with greater desire to defecate(P<0.05),but not associated with anal resting pressure,maximum anal squeeze pressure,first sensation,urgency to defecate,and maximal tolerable volume(P>0.05).Male,aged 60 or over,and difficult defecation were associated with higher incidence of paradoxical contraction of the anal sphincter during defecation(P<0.05).But types of stool,incomplete defecation,abdominal distension,and abdominal pain were not associated with the incidence of paradoxical contraction of the anal sphincter during defecation(P<0.05).Conclusion The main anorectal manometry results are pelvic floor dysfunction and inadequate defecatory propulsion in females with FC.Those FC patients aged 60 or over are found with increased prevalence of pelvic floor dysfunction and rectal hyposensitivity,indicating that the two factors are closely involved in the development of FC in old people.Accompanying abdominal distension and pain are closely associated with abnormally increased rectal volume thresholds and decreased rectal sensitivity.FC has complex etiology and high incidence,which severely impairs the quality of people's work and life.FC is associated with abnormal anal canal pressure and sensory function.The anorectal manometry analysis of FC helps to identify,quantify and evaluate the anal and rectal function,and to determine the pathogenesis of FC,offering a reference for the selection of treatment regimen and evaluation of the efficacy.
作者
闫小妮
殷燕
任晓阳
吕军
姚晚侠
YAN Xiaoni;YIN Yan;REN Xiaoyang;LYU Jun;YAO Wanxia(The First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China;School of Public Health,Xi'an Jiaotong University Health Science Center,Xi'an 710061,China;Medical School,Xi'an Peihua University,Xi'an 710125,China)
出处
《中国全科医学》
CAS
北大核心
2019年第24期2913-2917,2923,共6页
Chinese General Practice
基金
陕西省自然科学基础研究计划资助项目(2015JM8485)
关键词
便秘
结肠疾病
功能性
肛管
直肠
动力学
Constipation
Colonic diseases,functional
Anal canal
Rectum
Kinetics
