O'Connor Alexander, Byrne Caroline M, Heywood Nick, Davenport Matthew, Klarskov Niels, Sharma Abhiram, Kiff Edward, Telford Karen
Faculty of Biology, Medicine, and Health, The University of Manchester, Manchester, UK.
Department of Colorectal Surgery, Manchester University NHS Foundation Trust, Manchester, UK.
Colorectal Dis. 2024 Dec;26(12):2069-2079. doi: 10.1111/codi.17191. Epub 2024 Oct 6.
Rectal intussusception (RI) and external rectal prolapse (ERP) are associated with anal sphincter dysfunction. The aim of this study was to examine sphincter function with anal acoustic reflectometry (AAR) in RI and two distinct phenotypes of ERP termed high and low "take-off".
A prospective study of patients with RI and ERP attending a tertiary pelvic floor unit. Clinical data, AAR, and conventional anal manometry were analysed according to the Oxford prolapse grade.
A total of 108 (102 [94%] female, median age 62 years [range: 26-95]) patients were recruited into three groups according to prolapse grade: Oxford grades I and II (intrarectal RI, n = 34), Oxford grades III and IV (intra-anal RI, n = 35) and Oxford grade V (ERP, n = 39). As the grade of prolapse increased, resting AAR measurements of opening pressure, opening elastance, closing pressure, and closing elastance decreased (p < 0.001). Maximum resting pressure with manometry was reduced in ERP and intra-anal RI compared to intrarectal RI (p < 0.001). However, incremental squeeze function was not different between the three groups with either AAR or manometry (p > 0.05). There were no differences in AAR or manometry variables between grade IV RI (n = 18) and high take-off ERP (n = 20) (p > 0.05). By contrast, opening pressure (p = 0.010), closing pressure (p = 0.019) and elastance (p = 0.022) were reduced in low take-off ERP (n = 19).
Increasing rectal prolapse grade is associated with reduced anal sphincter function at rest indicating internal anal sphincter dysfunction. Physiological differences exist between high and low take-off ERP with sphincter function in the former similar to that seen in grade IV RI.
直肠套叠（RI）和直肠外脱垂（ERP）与肛门括约肌功能障碍相关。本研究旨在通过肛门声学反射测定法（AAR）检测RI以及ERP两种不同表型（即高“起始点”和低“起始点”）的括约肌功能。
对一家三级盆底疾病治疗中心的RI和ERP患者进行前瞻性研究。根据牛津脱垂分级分析临床数据、AAR和传统肛门测压结果。
根据脱垂分级，共108例患者（102例[94%]为女性，年龄中位数62岁[范围：26 - 95岁]）被分为三组：牛津I级和II级（直肠内RI，n = 34）、牛津III级和IV级（肛管内RI，n = 35）以及牛津V级（ERP，n = 39）。随着脱垂分级增加，静息状态下AAR测量的开口压力、开口弹性、闭合压力和闭合弹性均降低（p < 0.001）。与直肠内RI相比，ERP和肛管内RI的测压最大静息压力降低（p < 0.001）。然而，三组间AAR或测压的递增挤压功能无差异（p > 0.05）。IV级RI（n = 18）和高起始点ERP（n = 20）之间的AAR或测压变量无差异（p > 0.05）。相比之下，低起始点ERP（n = 19）的开口压力（p = 0.010）、闭合压力（p = 0.019）和弹性（p = 0.022）降低。
直肠脱垂分级增加与静息时肛门括约肌功能降低相关，提示肛门内括约肌功能障碍。高起始点和低起始点ERP之间存在生理差异，前者的括约肌功能与IV级RI相似。
