Geng Hong Zhi, Lin Xin, Xu Chen, Cong Jiying, Zhang Zhao, Li Yuwei
Department of Anorectal Surgery, Hepu People's Hospital, Zhuang Autonomous Region, Beihai City, Guangxi, China.
Department of Colorectal Surgery, Tianjin Union Medical Center, The First Affiliated Hospital of Nankai University, Hongqiao District, Tianjin, 190 Jieyuan Road, 300121, China.
Int J Colorectal Dis. 2025 Aug 7;40(1):172. doi: 10.1007/s00384-025-04963-1.
This study aimed to assess the diagnostic accuracy of combining anal relaxation rate (ARR) and maximum anal resting pressure (MARP), measured by three-dimensional (3D) high-resolution anorectal manometry (HR-ARM), in identifying high-risk phenotypes of severe rectocele in women (SRW) aged ≥ 50 years compared with healthy female volunteers (HFVs).
This retrospective comparative study was conducted at the Tianjin Union Medical Center (2018-2024) and included 50 SRW scheduled for surgery and 40 age-matched HFVs aged ≥ 50 years. Log-linear regression was used to assess interaction effects, and the Hosmer-Rothman additive model evaluated qualitative and quantitative interactions. Diagnostic accuracy was assessed using receiver operating characteristic curve analysis.
The concurrent elevation of ARR and MARP (R phenotype) was an independent risk factor (P < 0.01), surpassing the diagnostic value of individual parameters. Interaction analysis showed improved diagnostic accuracy, achieving a sensitivity of 82.0%, specificity of 100.0%, area under the curve of 0.82, Youden index of 0.82, odds ratio of 6.14, and 95% confidence interval of 2.19-17.17. Defecography-based classification with SRW-concomitant diseases may be identified using 3D HR-ARM phenotypes, whereas the reverse diagnostic pathway is not feasible. The integration of these modalities holds promise for guiding evidence-based personalized treatment strategies.
Age-stratified 3D HR-ARM analysis of ARR and MARP interactions may help identify high-risk R phenotypes in SRW, providing enhanced diagnostic specificity. The R phenotype identified in the preoperative X-ray defecography classification for SRW holds the potential for informing tailored therapeutic strategies.
本研究旨在评估通过三维（3D）高分辨率肛门直肠测压法（HR-ARM）测量的肛门松弛率（ARR）和最大肛门静息压（MARP）相结合，在识别年龄≥50岁的女性严重直肠膨出（SRW）与健康女性志愿者（HFV）相比的高危表型方面的诊断准确性。
这项回顾性比较研究在天津医科大学总医院进行（2018 - 2024年），纳入了50例计划手术的SRW和40例年龄匹配的≥50岁的HFV。采用对数线性回归评估交互作用，Hosmer-Rothman相加模型评估定性和定量交互作用。使用受试者工作特征曲线分析评估诊断准确性。
ARR和MARP同时升高（R表型）是一个独立危险因素（P < 0.01），超过了单个参数的诊断价值。交互分析显示诊断准确性提高，敏感性为82.0%，特异性为100.0%，曲线下面积为0.82，约登指数为0.82，比值比为6.14，95%置信区间为2.19 - 17.17。基于排粪造影的伴有SRW相关疾病的分类可通过3D HR-ARM表型识别，而反向诊断途径不可行。这些模式的整合有望指导基于证据的个性化治疗策略。
对ARR和MARP相互作用进行年龄分层的3D HR-ARM分析可能有助于识别SRW中的高危R表型，提高诊断特异性。在SRW术前X线排粪造影分类中识别出的R表型有可能为定制治疗策略提供依据。
