Barnes P R, Lennard-Jones J E
Gut. 1985 Oct;26(10):1049-52. doi: 10.1136/gut.26.10.1049.
The defaecatory mechanism using a balloon model with simultaneous measurement of intrarectal pressure has been studied in 15 control subjects with normal bowel habit and in 39 patients with chronic constipation; 31 with a normal barium enema and eight with idiopathic megarectum. Fourteen of those with a normal barium enema had prolonged whole gut transit times as measured by radio-opaque shapes. The ability of the patient to expel a rectal balloon containing 50, 100, and 150 ml of water, lying on their side in the left lateral position was tested and if unsuccessful, in the sitting position with the knees raised. All but one of the control subjects could expel balloons in the left lateral position. Only five of 17 constipated patients with normal barium enemas and transit times could expel balloons lying on their side although a further three could do so when sitting. None of 14 patients with slow transit and normal barium enemas could expel balloons in left lateral position although three could do so when sitting. Patients with megarectum could not expel balloons in either position. Levels of intrarectal pressure with straining were not significantly different between controls, who were able to expel balloons, and constipated patients with a normal barium enema, but were greater (p less than 0.01) in patients with megacolon than in control subjects. Using the balloon model a disorder of the defaecatory mechanism is present in patients with constipation of different types, but this is not because of an inability to raise intrarectal pressure.
我们使用带有直肠内压力同步测量功能的气囊模型，对15名排便习惯正常的对照者以及39名慢性便秘患者进行了排便机制研究；其中31名患者钡灌肠检查正常，8名患有特发性巨直肠。在通过不透X线形状测量时，31名钡灌肠检查正常的患者中有14名全肠道转运时间延长。测试了患者在左侧卧位时排出装有50、100和150毫升水的直肠气囊的能力，若不成功，则测试其在抬高膝盖的坐位时的排出能力。除一名对照者外，其他所有对照者均可在左侧卧位排出气囊。在17名钡灌肠和转运时间正常的便秘患者中，只有5名能在左侧卧位排出气囊，不过另有3名在坐位时可以排出。14名转运缓慢且钡灌肠正常的患者中，无人能在左侧卧位排出气囊，不过有3名在坐位时可以排出。巨直肠患者在两种体位下均无法排出气囊。用力时直肠内压力水平，在能够排出气囊的对照者与钡灌肠正常的便秘患者之间无显著差异，但在巨结肠患者中高于对照者（p<0.01）。使用气囊模型研究发现，不同类型便秘患者均存在排便机制紊乱，但这并非由于无法升高直肠内压力所致。
