Varma J S, Bradnock J, Smith R G, Smith A N
University Department of Surgery/Urology, Western General Hospital, Scotland, United Kingdom.
Dis Colon Rectum. 1988 Feb;31(2):111-5. doi: 10.1007/BF02562640.
Colorectal motility was studied in 25 elderly patients with chronic constipation and compared with an asymptomatic control group (N = 17). Proctometrograms were performed to measure rectal volumes at sensory threshold and maximal tolerance, and rectal compliance. Anal sphincter pressures and reflexes were measured by conventional techniques. Indices of colonic motility were also assessed. Significant impairment of rectal sensory threshold was apparent in constipation. Six patients presenting with impaction demonstrated functional megarectums. The remaining 19 showed a significant reduction in maximal rectal volume and rectal compliance and 14 extruded the balloon. There were no differences in sphincter length or presence of the rectosphincteric reflex. Four patients had an absent pudendoanal reflex and the remainder significant prolongation. Total gastrointestinal transit times were prolonged in the constipation group, mainly distally due to rectal stasis. In two patients bisacodyl failed to elicit a sigmoid motor response. Constipation in the elderly is not merely due to delayed transit. Neurogenic deficits of sacral spinal cord function may be responsible for abnormalities in rectal motor and sensory function.
对25例老年慢性便秘患者的结肠动力进行了研究，并与无症状对照组（n = 17）进行了比较。通过直肠测压图测量感觉阈值和最大耐受时的直肠容量以及直肠顺应性。采用传统技术测量肛门括约肌压力和反射。还评估了结肠动力指标。便秘患者的直肠感觉阈值明显受损。6例出现粪嵌塞的患者表现为功能性巨直肠。其余19例显示最大直肠容量和直肠顺应性显著降低，14例排出了气囊。括约肌长度或直肠括约肌反射的存在没有差异。4例患者阴部肛门反射消失，其余患者反射明显延长。便秘组的全胃肠通过时间延长，主要是由于直肠淤滞导致远端延长。2例患者使用比沙可啶未能引发乙状结肠运动反应。老年人便秘不仅仅是由于传输延迟。骶脊髓功能的神经源性缺陷可能是直肠运动和感觉功能异常的原因。
