Wald A, Caruana B J, Freimanis M G, Bauman D H, Hinds J P
Department of Medicine, Montefiore Hospital, University of Pittsburgh School of Medicine, Pennsylvania 15213.
Dig Dis Sci. 1990 Apr;35(4):481-7. doi: 10.1007/BF01536923.
We prospectively evaluated 36 patients who complained of chronic constipation and/or defecatory difficulties to determine the role of anorectal manometry and evacuation proctography in delineating the pathogenesis of these complaints. Twenty patients with constipation also underwent a colonic transit study with radioopaque markers, which identified one group with normal transit (N = 10) and another with slow transit (N = 10). Nine of 36 patients (25%) had inappropriate puborectalis muscle contraction or exhibited weak expulsion efforts during evacuation proctography, and these correlated highly with poor rectal emptying of barium paste (20 +/- 6% vs 61 +/- 5% in patients with normal relaxation; P less than 0.01). However, poor rectal emptying did not correlate with the presence of high-grade intussusceptions, large rectoceles, anorectal angles at rest or with straining, rectal diameter, clinical features, or colonic transit. Moreover, abnormal expulsion patterns as seen with anorectal manometry correlated poorly with the presence of inappropriate puborectalis contraction and decreased rectal emptying by proctography. Although anatomic abnormalities occurred frequently in patients with constipation and/or defecatory difficulties, they were also prevalent in asymptomatic controls. In view of these findings, surgical intervention to correct anatomic abnormalities in patients with constipation and/or defecatory difficulties should be considered only with great caution.
我们前瞻性地评估了36例主诉慢性便秘和/或排便困难的患者，以确定肛门直肠测压和排粪造影在阐明这些主诉发病机制中的作用。20例便秘患者还进行了不透X线标志物的结肠运输试验，确定了一组运输正常者（N = 10）和另一组运输缓慢者（N = 10）。36例患者中有9例（25%）在排粪造影时耻骨直肠肌收缩不当或排便时用力较弱，这些与钡剂糊剂直肠排空不良高度相关（正常松弛患者为20±6%，而正常松弛患者为61±5%；P<0.01）。然而，直肠排空不良与高度肠套叠、大直肠膨出、静息或用力时的肛管直肠角、直肠直径、临床特征或结肠运输无关。此外，肛门直肠测压所见的异常排便模式与耻骨直肠肌收缩不当及排粪造影时直肠排空减少的存在相关性较差。尽管解剖学异常在便秘和/或排便困难患者中经常出现，但在无症状对照者中也很普遍。鉴于这些发现，对于便秘和/或排便困难患者，仅在极为谨慎的情况下才应考虑手术干预以纠正解剖学异常。
