与健康成年人相比，三维高分辨率肛门直肠测压法在矛盾性耻骨直肠肌综合征诊断中的应用：一项79例的回顾性研究

Three-dimensional high-resolution anorectal manometry in the diagnosis of paradoxical puborectalis syndrome compared with healthy adults: a retrospective study in 79 cases.

作者信息

Xu Chen, Zhao Rong, Conklin Jeffrey L, Yang Xiaoqing, Zhang Yi, Zhang Xipeng, Qin Hai, Li Yuwei

机构信息

aDepartment of Colorectal Surgery, Nankai University Affiliated Hospital bDepartment of Endocrinology, The Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China cDivision of Digestive Diseases, The David Geffen School of Medicine at UCLA, Los Angeles, California, USA.

出版信息

Eur J Gastroenterol Hepatol. 2014 Jun;26(6):621-9. doi: 10.1097/MEG.0000000000000059.

DOI:10.1097/MEG.0000000000000059

PMID:24743503

Abstract

OBJECTIVES

The aim of this study is to evaluate the three-dimensional anorectal pressure topography of normal healthy adults and patients with paradoxical puborectalis syndrome (PPS) using a novel three-dimensional high-resolution manometry (3D-HRM) of the anorectum.

METHODS

The 3D-HRM probe has a 6.4 cm long sensing segment that is composed of 256 independent pressure transducers around its circumference. It generates a 3D pressure topographic profile of the anorectum. We evaluated 41 women and 38 men with PPS (median age 52 years), and compared them with 37 women and 34 men who were healthy (median age 51 years). The three-dimensional anorectal pressure topography was evaluated at rest, and during squeeze, stimulated defecation, and balloon inflation.

RESULTS

Maximum resting pressure, mean resting pressure, high pressure zone length, and residual anal pressure were significantly higher in patients with PPS compared with healthy adults (P<0.01 each). The rectoanal pressure differential was significantly lower in the PPS patients compared with healthy adults (P<0.05). There was a characteristic purple high-pressure area in the posterior wall of the pressure cylinder of patients with PPS during stimulated defecation that was absent in healthy adults. The longest diameter and widest diameter of this purple high-pressure area were 1.71 ± 0.25 and 1.07 ± 0.14 cm. The maximum, mean, and minimum pressures of the posterior distal pressure zone were significantly higher in patients with PPS (270.1 ± 8.2, 152.7 ± 4.8, and 51.9 ± 2.7 mmHg, respectively) compared with healthy adults (168.5 ± 11.1, 88.0 ± 5.9, and 30.7 ± 2.8 mmHg, respectively) (P<0.01).

CONCLUSION

Using the 3D-HRM technique, the increase in the resting pressure and residual anal pressure and decrease in the rectoanal pressure differential in patients with PPS compared with healthy adults further indicated the mechanism of this disease. Unlike traditional manometry, the 3D-HRM technique could find, locate, and evaluate the scope and the pressure of the paradoxical contraction of puborectalis muscle, which further indicates the value of manometry in terms of diagnosis.

摘要

目的

本研究旨在使用一种新型的直肠三维高分辨率测压法（3D-HRM）评估正常健康成年人及矛盾性耻骨直肠肌综合征（PPS）患者的三维直肠肛管压力地形图。

方法

3D-HRM探头有一个6.4厘米长的传感段，其圆周周围由256个独立的压力传感器组成。它能生成直肠肛管的三维压力地形图。我们评估了41名女性和38名男性PPS患者（中位年龄52岁），并将他们与37名女性和34名男性健康者（中位年龄51岁）进行比较。在静息状态、挤压时、模拟排便时和球囊充气时评估三维直肠肛管压力地形图。

结果

与健康成年人相比，PPS患者的最大静息压力、平均静息压力、高压区长度和残余肛管压力显著更高（每项P<0.01）。与健康成年人相比，PPS患者的直肠肛管压力差显著更低（P<0.05）。在模拟排便时，PPS患者压力筒后壁有一个特征性的紫色高压区，而健康成年人中不存在。这个紫色高压区的最长直径和最宽直径分别为1.71±0.25厘米和1.07±0.14厘米。与健康成年人（分别为168.5±11.1、88.0±5.9和30.7±2.8 mmHg）相比，PPS患者后远端压力区的最大、平均和最小压力显著更高（分别为270.1±8.2、152.7±4.8和51.9±2.7 mmHg）（P<0.01）。