Carrington E V, Brokjaer A, Craven H, Zarate N, Horrocks E J, Palit S, Jackson W, Duthie G S, Knowles C H, Lunniss P J, Scott S M
GI Physiology Unit, The Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine and Dentistry, London, UK; National Centre for Bowel Research and Surgical Innovation (NCRBSI), Barts and the London School of Medicine and Dentistry, London, UK.
Neurogastroenterol Motil. 2014 May;26(5):625-35. doi: 10.1111/nmo.12307. Epub 2014 Mar 13.
High-resolution anorectal manometry (HRAM) is a relatively new method for collection and interpretation of data relevant to sphincteric function, and for the first time allows a global appreciation of the anorectum as a functional unit. Historically, traditional anal manometry has been plagued by lack of standardization and healthy volunteer data of variable quality. The aims of this study were: (i) to obtain normative data sets for traditional measures of anorectal function using HRAM in healthy subjects and; (ii) to qualitatively describe novel physiological phenomena, which may be of future relevance when this method is applied to patients.
115 healthy subjects (96 female) underwent HRAM using a 10 channel, 12F solid-state catheter. Measurements were performed during rest, squeeze, cough, and simulated defecation (push). Data were displayed as color contour plots and analysed using a commercially available manometric system (Solar GI HRM v9.1, Medical Measurement Systems). Associations between age, gender and parity were subsequently explored.
HRAM color contour plots provided clear delineation of the high-pressure zone within the anal canal and showed recruitment during maneuvers that altered intra-anal pressures. Automated analysis produced quantitative data, which have been presented on the basis of gender and parity due to the effect of these covariates on some sphincter functions. In line with traditional manometry, some age and gender differences were seen. Males had a greater functional anal canal length and anal pressures during the cough maneuver. Parity in females was associated with reduced squeeze increments.
CONCLUSIONS & INFERENCES: The study provides a large healthy volunteer dataset and parameters of traditional measures of anorectal function. A number of novel phenomena are appreciated, the significance of which will require further analysis and comparisons with patient populations.
高分辨率肛门直肠测压法（HRAM）是一种相对较新的数据收集和解读方法，用于获取与括约肌功能相关的数据，首次使人们能够从整体上认识肛门直肠作为一个功能单位。从历史上看，传统的肛门测压法一直存在缺乏标准化以及健康志愿者数据质量参差不齐的问题。本研究的目的是：（i）使用HRAM获取健康受试者肛门直肠功能传统测量指标的规范数据集；（ii）定性描述新的生理现象，当该方法应用于患者时，这些现象可能具有未来相关性。
115名健康受试者（96名女性）使用10通道、12F固态导管进行HRAM检查。在静息、挤压、咳嗽和模拟排便（推）过程中进行测量。数据以彩色等高线图显示，并使用商用测压系统（Solar GI HRM v9.1，Medical Measurement Systems）进行分析。随后探讨年龄、性别和生育状况之间的关联。
HRAM彩色等高线图清晰描绘了肛管内的高压区，并显示在改变肛管内压力的动作过程中高压区的变化。自动分析产生了定量数据，由于这些协变量对某些括约肌功能有影响，因此已根据性别和生育状况呈现这些数据。与传统测压法一致，观察到了一些年龄和性别差异。男性在咳嗽动作时肛管功能长度更长，肛管压力更高。女性的生育状况与挤压增量减少有关。
本研究提供了一个大型健康志愿者数据集以及肛门直肠功能传统测量指标的参数。认识到了一些新现象，其意义需要进一步分析并与患者群体进行比较。
