Pescatori M, Maria G, Mattana C, Vulpio C, Vecchio F
Dis Colon Rectum. 1985 Nov;28(11):862-7. doi: 10.1007/BF02555494.
Clinical examination, proctosigmoidoscopy, rectal biopsies, barium enema and pelvic floor physiology studies were performed in four patients with solitary rectal ulcer syndrome. All patients had chronic constipation and rectal bleeding. Resting tone and voluntary contraction were found to be decreased at anal manometry in two patients (maximal squeeze pressures were ten and 35 mm Hg, respectively). Balloon proctogram showed an increased rectoanal angle in these two patients (90 degrees and 93 degrees at rest, unchanged on squeezing) with a poor striated sphincter function at EMG; their deficient anal reflex, slight fecal incontinence and perineal descent seemed consistent with pudendal neuropathy. Fibromuscular obliteration of the lamina propria was found at histology. All subjects had successful conservative treatment, including topical corticosteroids in one patient; normalization of bowel habit was the most effective therapy for the disease. The present study seems to confirm the role of chronic constipation and abnormal pelvic floor physiology in the pathogenesis of the syndrome.
对4例孤立性直肠溃疡综合征患者进行了临床检查、直肠乙状结肠镜检查、直肠活检、钡灌肠和盆底生理学研究。所有患者均有慢性便秘和直肠出血。两名患者肛门测压时发现静息张力和随意收缩降低（最大挤压压力分别为10和35 mmHg）。气囊直肠造影显示这两名患者直肠肛管角增大（静息时分别为90度和93度，挤压时不变），肌电图显示横纹括约肌功能不良；他们的肛门反射缺失、轻度大便失禁和会阴下降似乎与阴部神经病变一致。组织学检查发现固有层纤维肌肉闭塞。所有受试者均接受了成功的保守治疗，其中1例患者使用了局部皮质类固醇；排便习惯正常化是该病最有效的治疗方法。本研究似乎证实了慢性便秘和异常盆底生理学在该综合征发病机制中的作用。
