Kang Hye Ran, Lee Ji-Eun, Lee Joon Seong, Lee Tae Hee, Hong Su Jin, Kim Jin Oh, Jeon Seong Ran, Kim Hyun Gun
Institute for Digestive Research, Soonchunhyang University, College of Medicien, Seoul, Korea.
J Neurogastroenterol Motil. 2015 Jan 1;21(1):126-32. doi: 10.5056/jnm14025.
BACKGROUND/AIMS: To date, high-resolution manometry has been used mainly in the study of esophageal motility disorders and has been shown to provide more physiological information than conventional manometry, and is easier to interpret. This study aimed to evaluate the usefulness of high-resolution anorectal manometry (HRARM) compared to water-perfused anorectal manometry.
Patients who complained of chronic constipation with/without fecal incontinence underwent both water-perfused anorectal manometry and HRARM in a random order on the same day. Resting and squeezing pressures of the anal sphincter, attempted defecation, rectoanal inhibitory reflex, rectoanal contractile reflex, Rao's type of dyssynergia during attempted defecation, anal canal length, defecation dynamic parameters and measurement times for each method were analyzed.
Of 14 patients, 7 were female, and the median age was 59 years (range 35-77). Indications for manometry were constipation (n = 8) and constipation with fecal incontinence (n = 6). Resting and squeezing pressures showed that the two methods were strongly correlated (resting pressure: r = 0.746, P = 0.002; squeezing pressure: r = 0.921, P < 0.001). In attempted defection, one equivocal case with water-perfused anorectal manometry was diagnosed type I pelvic floor dyssynergia with HRARM providing detailed pressure changes in internal and external anal spincters, and puborectalis muscle which improved assessment of anorectal disorders. The measurement time for HRARM was significantly shorter than that for water-perfused anorectal manometry (11.3 vs. 23.0 minutes, P < 0.001).
Both water-perfused anorectal manometry and HRARM are well tolerated and reliable methods of evaluating defecation disorders of pelvic floor dysfunction. HRARM is likely to provide better physiological information and to require a shorter measurement time compared to water-perfused anorectal manometry.
背景/目的：迄今为止，高分辨率测压主要用于食管动力障碍的研究，已证明其比传统测压能提供更多生理信息，且更易于解读。本研究旨在评估高分辨率肛门直肠测压（HRARM）与水灌注肛门直肠测压相比的实用性。
主诉有慢性便秘伴/不伴大便失禁的患者在同一天按随机顺序接受水灌注肛门直肠测压和HRARM检查。分析了肛门括约肌的静息和收缩压力、排便尝试、直肠肛门抑制反射、直肠肛门收缩反射、排便尝试时的Rao型协同失调、肛管长度、排便动力学参数以及每种方法的测量时间。
14例患者中，7例为女性，中位年龄为59岁（范围35 - 至77岁）。测压指征为便秘（n = 8）和便秘伴大便失禁（n = 6）。静息和收缩压力显示两种方法高度相关（静息压力：r = 0.746，P = = 0.002；收缩压力：r = 0.921，P < 0.001）。在排便尝试中，水灌注肛门直肠测压的1例可疑病例经HRARM诊断为I型盆底协同失调，HRARM能提供肛门内外括约肌及耻骨直肠肌详细的压力变化，改善了对肛门直肠疾病的评估。HRARM的测量时间明显短于水灌注肛门直肠测压（11.3分钟对23.0分钟，P < 0.001）。
水灌注肛门直肠测压和HRARM都是评估盆底功能障碍排便障碍耐受性良好且可靠的方法。与水灌注肛门直肠测压相比，HRARM可能提供更好的生理信息且测量时间更短。
