Raza Naeem, Bielefeldt Klaus
Division of Gastroenterology, University of Pittsburgh, Pittsburgh, PA 15213, USA.
Dig Dis Sci. 2009 Nov;54(11):2503-11. doi: 10.1007/s10620-008-0631-1. Epub 2008 Dec 18.
Guidelines recommend anorectal manometry in patients with fecal incontinence and chronic constipation. However, limited evidence supports the utility of manometric testing. We retrospectively reviewed tracings obtained between November 2005 and May 2008. A total of 298 patients (86% women; average age 52 years) were included. The main indications were incontinence (51%) and constipation (42%). Patients suffering from incontinence were older and had lower resting and squeeze pressure compared to continent patients. However, the discriminative power of manometric pressure data was poor, with low sensitivity and specificity. An abnormal straining pattern suggesting dyssynergic defecation was seen in 43% of constipated patients compared to 13% of patients with fecal incontinence. A concordance between manometric patterns and the balloon expulsion test was seen in 72%. The low sensitivity and specificity of manometric parameters does not support the routine use of anorectal manometry in patients with defecation disorders.
指南建议对大便失禁和慢性便秘患者进行肛门直肠测压。然而，仅有有限的证据支持测压检查的实用性。我们回顾性分析了2005年11月至2008年5月期间获取的记录。共纳入298例患者（86%为女性；平均年龄52岁）。主要适应证为大便失禁（51%）和便秘（42%）。与大便能自控的患者相比，大便失禁患者年龄更大，静息压和收缩压更低。然而，测压压力数据的鉴别能力较差，敏感性和特异性较低。43%的便秘患者存在提示排便协同失调的异常用力模式，而大便失禁患者中这一比例为13%。72%的患者测压模式与气囊排出试验结果一致。测压参数的低敏感性和特异性不支持在排便障碍患者中常规使用肛门直肠测压。
