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[目的]研究出口梗阻型便秘(OOC)患者肛门直肠动力及直肠感知功能特点。[方法]选取57例出口梗阻型便秘患者(OOC组),另选取27例健康志愿者(对照组)进行高分辨率肛门直肠测压检测,对比2组肛门直肠动力及直肠感知功能。[结果](1)OOC组最大肛管静息压(MARP)、肛门括约肌功能长度、缩榨持续时间及直肠排便压与对照组比较,差异无统计学意义。OOC组最大肛门括约肌收缩压(MASP)、模拟排便时肛管残余压均高于对照组,而模拟排便时肛管松弛率低于正常组,且差异均有统计学意义(P<0.01);(2)与健康志愿者比较,OOC组最小松弛容积及直肠最大耐受量均高于对照组,但差异无统计学意义。OOC组直肠初始感觉阈值及初始便意阈值均高于对照组,差异有统计学意义(P<0.05);(3)女性OOC患者MARP、模拟排便时肛管残余压及肛管松弛率、最小松弛容积、初始感觉阈值、初始便意阈值、最大耐受量均高于男性OOC患者,但差异无统计学意义(P>0.05)。女性OOC患者肛门括约肌功能长度、缩榨持续时间、直肠排便压较男性OOC患者降低不明显(P>0.05),而女性OOC患者MASP较男性患者降低,差异有统计学意义(P<0.05)。[结论](1)OOC患者肛门外括约肌及盆底肌的收缩及协调功能障碍、直肠敏感性下降及对容量刺激的反应较迟钝可能是造成出口梗阻型便秘的重要原因;(2)女性OOC患者肛门外括约肌及盆底肌的收缩功能较男性弱。
[Objective] To study the characteristics of anorectal motility and rectal sensation in patients with obstructive outlet obstruction (OOC). [Methods] Fifty-seven patients with obstructive outlet obstruction (OOC group) and 27 healthy volunteers (control group) were enrolled in this study. High-resolution anorectal manometry was performed to compare anorectal motility and rectal sensation. [Results] (1) The maximal anal canal resting pressure (MARP), anal sphincter function length, squeezing duration and rectal defecation pressure in OOC group were not significantly different from those in control group. The maximal anal sphincter systolic pressure (MASP) in OOC group was higher than that of the control group, but the anal canal relaxation rate was lower in simulated defecation than in normal group (P <0.01). (2) Compared with healthy volunteers, the minimum relaxation volume and maximal rectal tolerance in OOC group were higher than those in control group, but the difference was not statistically significant. OOC group, the initial rectal threshold and initial threshold of rectal sensitivity were significantly higher than those of the control group (P <0.05). (3) The MARP of female OOC patients, anal canal residual pressure and anal canal relaxation rate, minimum relaxation Volume, initial threshold of sensation, threshold of initial intention and maximum tolerance were higher than those of OOC patients, but the difference was not statistically significant (P> 0.05). The functional length of anal sphincter, duration of shrinkage and rectal defecation in OOC patients were not significantly lower than those in OOC patients (P> 0.05). Female OOC patients had lower MASP than male patients. The difference was statistically significant (P <0.05). [Conclusion] (1) OOC patients with anal sphincter and pelvic floor muscle contraction and coordination dysfunction, rectal sensitivity decreased and the response to volume stimulation more sluggish may be caused by outlet obstruction constipation an important reason; (2) female OOC Patients with anal sphincter and pelvic floor muscle contraction function is weaker than men.