Academic Surgical Unit & Neurogastroenterology Group, Barts and The London School of Medicine and Dentistry, Queen Mary University London, United Kingdom.
Best Pract Res Clin Gastroenterol. 2011 Feb;25(1):103-18. doi: 10.1016/j.bpg.2011.01.001.
The pathophysiological mechanisms underlying chronic constipation in both adults and children remain to be unravelled. This is a not inconsiderable challenge, but is fundamental to improving management of such patients. Rectal sensorimotor function, which encompasses both sensation and motility, as well as biomechanical components (compliance, capacity), is now strongly implicated in the pathogenesis of constipation. Rectal hyposensitivity, rectal hypercompliance, increased rectal capacity, rectal motor dysfunction (phasic contractility and tone), and altered rectoanal reflex activity are all found in constipated patients, particularly in association with 'functional' disorders of defaecation (i.e. pelvic floor dyssynergia). This review covers contemporary understanding of how components of rectal sensorimotor function may contribute to symptom development in both adult and paediatric populations. The complex interaction between sensory/motor/biomechanical domains, and how best to measure these functions are addressed, and where data exist, the impact of sensorimotor dysfunction on therapeutic outcomes is highlighted.
成人和儿童慢性便秘的病理生理机制仍有待阐明。这是一个相当大的挑战，但对于改善此类患者的管理至关重要。直肠感觉运动功能包括感觉和运动以及生物力学成分（顺应性、容量），目前强烈提示与便秘的发病机制有关。直肠低敏、直肠高顺应性、直肠容量增加、直肠运动功能障碍（时相收缩性和张力）以及直肠肛门反射活动改变均见于便秘患者，尤其是与“功能性”排便障碍（即盆底协同失调）相关时。这篇综述涵盖了对直肠感觉运动功能各组成部分如何有助于成人和儿童人群症状发展的现代认识。本文讨论了感觉/运动/生物力学领域之间的复杂相互作用，以及如何最好地测量这些功能，并在有数据的情况下，强调了感觉运动功能障碍对治疗结果的影响。
