Yoshioka K, Hyland G, Keighley M R
Department of Surgery, General Hospital, Birmingham, UK.
Br J Surg. 1988 Dec;75(12):1220-4. doi: 10.1002/bjs.1800751225.
Nineteen patients have been studied before and 3 months after postanal repair. Physiological parameters have been compared with 16 age- and sex-matched controls. Twelve patients were substantially improved whereas seven obtained no clinical benefit. Pre-operative resting (P less than 0.005), squeeze (P less than 0.005) and strain (P less than 0.005) anal pressures at 2 cm were significantly less than controls. Similarly, pressures during all three events at 4 cm were significantly less than controls (resting P less than 0.05, squeeze P less than 0.005, strain P less than 0.025). Median volume of first leak during saline infusion was significantly less than controls (P less than 0.005) as was the total tolerable volume (P less than 0.005). Videoproctographic parameters which differed significantly from controls included pelvic floor descent at rest (P less than 0.005), during contraction (P less than 0.005) and straining (P less than 0.05); resting and squeeze perineal descent (P less than 0.005); and anal canal length at rest and straining (P less than 0.005). Anorectal angles, rectal compliance, rectal sensation and emptying did not differ from controls. None of these parameters was improved by postanal repair. Patients not improved by operation could be detected pre-operatively by low resting (P less than 0.05), squeeze (P less than 0.025) and strain (P less than 0.05) anal pressure at 2 cm as well as by videoproctographic evidence of increased pelvic floor descent at rest (P less than 0.01), during contraction (P less than 0.005) and straining (P less than 0.005), excessive perineal descent at rest (P less than 0.05), during contraction (P less than 0.05) and during attempted defaecation (P less than 0.05) and a short anal canal at rest (P less than 0.05) and during straining (P less than 0.025).
对19例患者在肛门后修复术前及术后3个月进行了研究。将生理参数与16名年龄和性别匹配的对照组进行了比较。12例患者有显著改善，而7例未获得临床益处。术前2厘米处静息（P<0.005）、挤压（P<0.005）和用力时（P<0.005）的肛管压力显著低于对照组。同样，4厘米处所有三种情况下的压力也显著低于对照组（静息P<0.05，挤压P<0.005，用力P<0.025）。盐水灌注期间首次渗漏的中位体积显著低于对照组（P<0.005），总耐受体积也是如此（P<0.005）。与对照组有显著差异的视频直肠造影参数包括静息时（P<0.005）、收缩时（P<0.005）和用力时（P<0.05）的盆底下降；静息和挤压时的会阴下降（P<0.005）；以及静息和用力时的肛管长度（P<0.005）。肛管直肠角、直肠顺应性、直肠感觉和排空与对照组无差异。肛门后修复未改善这些参数中的任何一项。术前静息（P<0.05）、挤压（P<0.025）和用力时（P<0.05）肛管压力低，以及视频直肠造影显示静息时（P<0.01）、收缩时（P<0.005）和用力时（P<0.005）盆底下降增加、静息时（P<0.05）、收缩时（P<0.05）和试图排便时（P<0.05）会阴下降过多、静息时（P<0.05）和用力时（P<0.025）肛管短，可检测出手术未改善的患者。
