Weber J, Delangre T, Hannequin D, Beuret-Blanquart F, Denis P
Clinique Neurologique, U.E.R. Medecine et Pharmacie de Rouen, Saint Etienne du Rouvray, France.
Dig Dis Sci. 1990 Feb;35(2):225-30. doi: 10.1007/BF01536767.
We studied the anorectal manometric and urodynamic pattern of seven patients who had right and/or left frontal lobe injury to investigate the possibility that the frontal lobe area plays an important role in control of anorectal motility as it does for the urinary bladder. We found that the disturbances of anorectal manometric recordings were similar to those of urodynamic recordings: (1) lack of urinary bladder filling sensation (two cases), increased perception threshold of rectal distension (two cases); (2) uninhibited detrusor contractions during filling (five cases), spontaneous rectal contractions during the resting step (four cases); (3) absence of micturition (one case), absence of rectoanal inhibitory reflex (one case). Furthermore, in all but one patient, we observed a decrease in the amplitude and duration of the voluntary contraction of the anal canal (six cases). However, in two of the seven patients we found hypertonia in the anal canal (upper part: one case, lower part: one case), but never in the urethral canal. Our results suggest that frontal lobe may be involved in the nervous control of anorectal motility as it is for urinary bladder function. However, the lack of correlation between urinary and anorectal anomalies in individual cases suggests that these functions depend on distinct areas of the frontal lobe.
我们研究了7例右侧和/或左侧额叶损伤患者的肛肠测压和尿动力学模式，以探讨额叶区域是否如对膀胱功能一样，在控制肛肠运动中发挥重要作用。我们发现，肛肠测压记录的紊乱与尿动力学记录的紊乱相似：（1）膀胱充盈感觉缺失（2例），直肠扩张感知阈值增加（2例）；（2）充盈期逼尿肌无抑制性收缩（5例），静息期直肠自发性收缩（4例）；（3）无排尿（1例），直肠肛门抑制反射缺失（1例）。此外，除1例患者外，其余所有患者我们均观察到肛管随意收缩的幅度和持续时间降低（6例）。然而，在7例患者中的2例，我们发现肛管张力亢进（上部：1例，下部：1例），但尿道从未出现。我们的结果表明，额叶可能如对膀胱功能一样，参与了肛肠运动的神经控制。然而，个别病例中泌尿和肛肠异常之间缺乏相关性，表明这些功能依赖于额叶的不同区域。
