Li Wen-cheng, Xiao Chuan-guo
Neuroscience Center and Department of Urology, Xiehe Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
Chin J Traumatol. 2006 Aug;9(4):217-22.
To investigate the anorectal status in patients with lumbosacral spinal cord injury (SCI).
Twenty six patients (23 males, 3 females) with lumbosacral SCI and 13 normal volunteers were enrolled into this study as controls. The median age was 43.7 years (ranging 17-68 years) and the median time of patients since injury was 59.1 months (ranging 8 months-15 years). They were diagnosed as complete lumbosacral SCI (n =2, American Spinal Injury Association (ASIA) score A), or incomplete lumbosacral SCI (n=24, ASIA score B-D) with mixed symptoms of constipation and/or fecal incontinence, and were studied by anorectal manometry. None of the patients had any medical treatments for neurogenic bowel prior to this study.
The maximum anal resting pressure in lumbosacral SCI patients group was slightly lower than that in control group (One-way ANOVA: P=0.939). During defecatory maneuvers, 23 of 26 (88.5%) patients with lumbosacral SCI and 1 of 13 (7.7%) in the control group showed pelvic floor dysfunction (PFD) (Fisher's exact test: P<0.0001). Rectoanal inhibitory reflex (RAIR) was identified in both patients with lumbosacral SCI and the controls. The rectal volume for sustained relaxation of the anal sphincter tone in lumbosacral SCI patients group was significantly higher than that in the control group (Independent-Samples t test: P<0.0001). The mean rectal volume to generate the first sensation was 92.7 ml+/-57.1 ml in SCI patients, 41.5 ml+/-13.4 ml in the control group (Independent-Samples t test: P<0.0001).
Most of the patients with lumbosacral SCI show PFD during defecatory maneuvers and their rectal sensation functions are severely damaged. Some patients exhibit abnormal cough reflex. Anorectal manometry may be helpful to find the unidentified supraconal lesions. RAIR may be modulated by central nervous system (CNS).
探讨腰骶部脊髓损伤（SCI）患者的肛肠状况。
本研究纳入26例腰骶部SCI患者（23例男性，3例女性）和13名正常志愿者作为对照。患者的年龄中位数为43.7岁（范围17 - 68岁），受伤后的时间中位数为59.1个月（范围8个月 - 15年）。他们被诊断为完全性腰骶部SCI（n = 2，美国脊髓损伤协会（ASIA）评分A）或不完全性腰骶部SCI（n = 24，ASIA评分B - D），伴有便秘和/或大便失禁的混合症状，并接受了肛肠测压检查。在本研究之前，所有患者均未接受过任何针对神经源性肠道的医学治疗。
腰骶部SCI患者组的最大肛管静息压略低于对照组（单因素方差分析：P = 0.939）。在排便动作期间，26例腰骶部SCI患者中的23例（88.5%）和对照组13例中的1例（7.7%）表现出盆底功能障碍（PFD）（Fisher精确检验：P < 0.0001）。腰骶部SCI患者和对照组均存在直肠肛门抑制反射（RAIR）。腰骶部SCI患者组中使肛门括约肌张力持续松弛的直肠容量显著高于对照组（独立样本t检验：P < 0.0001）。SCI患者产生首次便意的平均直肠容量为92.7 ml ± 57.1 ml，对照组为41.5 ml ± 13.4 ml（独立样本t检验：P < 0.0001）。
大多数腰骶部SCI患者在排便动作期间表现出PFD，其直肠感觉功能严重受损。部分患者表现出异常咳嗽反射。肛肠测压可能有助于发现未明确的圆锥以上病变。RAIR可能受中枢神经系统（CNS）调节。
