Department of Gastrointestinal Physiology, Castle Hill Hospital, Hull and East Yorkshire Hospitals NHS Trust, Cottingham, UK.
The Centre for Trauma and Surgery and GI Physiology Unit, The Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
Neurogastroenterol Motil. 2017 Nov;29(11). doi: 10.1111/nmo.13124. Epub 2017 Jun 22.
Anorectal manometry is the most commonly performed investigation for assessment of anorectal dysfunction. Findings from previous studies comparing water-perfused (WP) and solid-state (SS) techniques in the anorectum are conflicting. We compared anal sphincter pressure at rest and during dynamic maneuvers (squeezing and coughing) in healthy volunteers using SS and WP high-resolution anorectal manometry (HR-ARM) employing equivalent catheter configurations, a standardized protocol, and identical data acquisition and analysis software.
Sixty healthy volunteers (40F; median age: 40; range: 18-74) underwent WP and SS HR-ARM in randomized order. Anal resting pressure, and squeeze and cough increments were measured. Median pressure and 5th and 95th percentiles were calculated for each maneuver and compared using Wilcoxon signed-rank test. Bland and Altman plots were used to assess agreement between the systems. The impact of gender and parity was also explored.
Anal sphincter pressure measurements during squeeze (P<.001) and cough (P<.001) were significantly higher using SS HR-ARM than WP HR-ARM. No differences were seen at rest between the two types of catheter (nulliparous: P=.304; parous: P=.390; males: P=.167). Normal ranges for SS and WP manometry from this small group of healthy volunteers are presented.
CONCLUSIONS & INFERENCES: Greater sensitivity to rapid pressure change is one of the advantages associated with SS HR-ARM. This is reflected in the differences observed during dynamic maneuvers performed during this study. Catheter type should be taken into consideration when selecting normal ranges for comparison to disease states.
直肠肛门测压是评估肛肠功能最常用的检查方法。既往比较水灌注（WP）和固态（SS）技术在直肠肛门中的研究结果存在争议。我们比较了使用 SS 和 WP 高分辨率直肠肛门测压（HR-ARM）的健康志愿者在静息和动态（收缩和咳嗽）时的肛门括约肌压力，两种技术采用相同的导管配置、标准化方案以及相同的数据采集和分析软件。
60 名健康志愿者（40 名女性；中位年龄：40 岁；范围：18-74 岁）按随机顺序接受 WP 和 SS HR-ARM 检查。测量肛门静息压和收缩、咳嗽时的压力增量。计算每个动作的中位数压力和第 5 百分位数和第 95 百分位数，并使用 Wilcoxon 符号秩检验进行比较。采用 Bland-Altman 图评估两种系统的一致性。还探讨了性别和产次的影响。
在收缩（P<.001）和咳嗽（P<.001）时，SS HR-ARM 测量的肛门括约肌压力明显高于 WP HR-ARM。两种导管在静息时无差异（未产妇：P=.304；经产妇：P=.390；男性：P=.167）。从这一小群健康志愿者中获得了 SS 和 WP 测压的正常范围。
对快速压力变化的更高敏感性是 SS HR-ARM 相关的优势之一。这反映在本研究中观察到的动态动作中的差异。在选择与疾病状态进行比较的正常范围时，应考虑导管类型。
