Read N W, Haynes W G, Bartolo D C, Hall J, Read M G, Donnelly T C, Johnson A G
Gastroenterology. 1983 Jul;85(1):105-13.
Anal and rectal pressures and external sphincter electromyogram were recorded continuously during rectal infusion of 1.5 L saline in 18 normal subjects and 37 patients who complained of diarrhea and fecal incontinence. All subjects exhibited a pattern of regular fluctuations in anorectal pressure and electromyogram. All except 1 of the normal subjects were able to retain 1500 ml saline without leakage, and their pressure record comprised simultaneous rectal contractions, internal sphincter relaxations, and external sphincter contractions. None of the incontinent patients were able to retain 1500 ml saline without leakages, and leakages always coincided with the peaks of rectal pressure. Two manometric patterns were observed. Fifty-nine percent of incontinent patients exhibited a pattern of contractions of similar profile occurring throughout the anorectum. This finding was associated with low basal sphincter pressures, an easily inhibited anal sphincter tone, an obtuse anorectal angle, and a funnel-shaped configuration to the anal canal. These results suggested that, in this group, the internal sphincter was weak and easily inhibited so that the whole anorectum behaved as one fluid-filled compartment recording contractions of the external sphincter. The remaining 41% of incontinent patients exhibited a normal pattern of anorectal pressure fluctuations and had normal maximum basal pressures, although maximum squeeze pressures, rectoanal inhibitory reflex, and anorectal angles were abnormal. Peak rectal pressures were abnormally high in this group during saline infusion, suggesting that abnormally strong rectal contractions may play a role in the incontinence in this group.
在向18名正常受试者和37名主诉腹泻和大便失禁的患者直肠输注1.5升生理盐水的过程中，持续记录肛门和直肠压力以及外括约肌肌电图。所有受试者的肛门直肠压力和肌电图均呈现出规律的波动模式。除1名正常受试者外，其他所有正常受试者均能保留1500毫升生理盐水而无渗漏，他们的压力记录包括直肠同时收缩、内括约肌松弛和外括约肌收缩。所有大便失禁患者均无法保留1500毫升生理盐水而无渗漏，渗漏总是与直肠压力峰值同时出现。观察到两种测压模式。59%的大便失禁患者在整个肛门直肠区域呈现出类似轮廓的收缩模式。这一发现与基础括约肌压力低、肛门括约肌张力易于抑制、直肠肛管角钝以及肛管呈漏斗状结构有关。这些结果表明，在这组患者中，内括约肌薄弱且易于抑制，以至于整个肛门直肠表现为一个充满液体的腔室，记录外括约肌的收缩情况。其余41%的大便失禁患者呈现出正常的肛门直肠压力波动模式，最大基础压力正常，尽管最大挤压压力、直肠肛管抑制反射和直肠肛管角异常。在这组患者中，生理盐水输注期间直肠压力峰值异常高，表明异常强烈的直肠收缩可能在这组患者的失禁中起作用。
