National Bowel Research Centre and GI Physiology Unit, Blizard Institute, Centre for Surgery & Trauma, Queen Mary University of London, London, UK.
Hospital Germans Trías i Pujol, Barcelona, Spain.
Neurogastroenterol Motil. 2019 Mar;31(3):e13532. doi: 10.1111/nmo.13532. Epub 2019 Jan 13.
Using high-resolution anorectal manometry, we aimed to evaluate the: (a) optimal threshold to measure functional anal canal length (FACL) with intra- and inter-observer variability; (b) relationship between abnormal FACL and other phenotypic findings; and (c) utility of FACL measurement to discriminate between healthy volunteers (HV) and patients with fecal incontinence (FI) or chronic constipation (CC).
Consecutive patients referred for investigation of FI or CC in isolation were included. FACL was calculated at 5, 10, 20, 30, and 50 mm Hg above rectal pressure. 5th-95th percentile in HV defined limits of normality.
FACL was analyzed in 192 patients with FI (154 females), 204 patients with CC (175 females), and 134 HV (101 females). The optimal threshold for measurement of FACL was 20 mm Hg. Using this threshold, observer reproducibility was very high (ICC 0.99, P < 0.0001). FACL was shorter in females with FI and longer in females with CC compared to HV (2.3 vs 2.9 cm; and 3.4 cm vs 2.9 cm; both P < 0.0001). Twenty percent of females and 13% males with FI had a short FACL, associated with older age, anal hypotonia or hypocontractility, and a atrophic internal anal sphincter. However, abnormal FACL in isolation was only found in 1/190 FI (0.5%) and 2/201 CC (1%) patients; all other patients had other abnormal manometric findings.
Considering overlap with other routinely evaluated manometric parameters, FACL measurement does not provide additional information in the diagnostic assessment of FI or CC.
我们使用高分辨率肛门直肠测压法来评估：（a）测量功能性肛门内管长度（FACL）的最佳阈值，包括观察者内和观察者间的可变性；（b）异常 FACL 与其他表型发现之间的关系；以及（c）FACL 测量值区分健康志愿者（HV）与粪便失禁（FI）或慢性便秘（CC）患者的效用。
连续纳入因 FI 或 CC 而孤立接受检查的患者。在直肠压力升高 5、10、20、30 和 50mmHg 时计算 FACL。HV 的 5 至 95 百分位数定义为正常值范围。
分析了 192 例 FI 患者（154 例女性）、204 例 CC 患者（175 例女性）和 134 例 HV（101 例女性）的 FACL。测量 FACL 的最佳阈值为 20mmHg。使用该阈值，观察者的可重复性非常高（ICC 0.99，P<0.0001）。与 HV 相比，FI 女性的 FACL 较短，而 CC 女性的 FACL 较长（2.3cm 与 2.9cm；均 P<0.0001）。20%的 FI 女性和 13%的男性 FI 患者 FACL 较短，与年龄较大、肛门张力减退或收缩力不足以及内肛括约肌萎缩有关。然而，孤立性异常 FACL 仅在 190 例 FI 患者中的 1 例（0.5%）和 201 例 CC 患者中的 2 例（1%）中发现；所有其他患者均存在其他异常测压发现。
考虑到与其他常规评估的测压参数的重叠，FACL 测量在 FI 或 CC 的诊断评估中并未提供额外信息。
