Siproudhis L, Dautrème S, Ropert A, Briand H, Renet C, Beusnel C, Juguet F, Rabot A F, Bretagne J F, Gosselin M
Services d'Explorations Fonctionnelles et de Gastroentérologie, Hôpital Pontchaillou, Rennes, France.
Eur J Gastroenterol Hepatol. 1995 Jun;7(6):547-52.
Biofeedback is the main treatment for dyschezia in patients with anismus, but retraining may fail because of the frequent association of pelvirectal disorders with anismus. We set out to identify indices of biofeedback failure in the treatment of anismus.
From May 1990 to May 1993, 27 patients (20 women and seven men; median age 46 years) with anismus in which dyschezia was not improved by laxative agents were enrolled in a biofeedback retraining programme. All patients underwent proctologic examination, anal manometry and defecography. Anismus was defined as an increase in anal pressure during attempted defecation in conjunction with an impairment of rectal emptying as assessed using an objective test (barium paste expulsion). Associated disorders were encountered frequently. These included abnormal perineal descent (22 cases), large rectocoele (12 cases), high-grade rectal prolapse (six cases), abnormally high anal canal pressures at rest (seven cases) and abnormal rectal response to inflation (20 cases). Anismus was the sole abnormality in 12 patients when perineal descent, low-grade prolapse and abnormal rectal sensations were not taken into account.
Biofeedback retraining did not suppress dyschezia in 13 out of 27 patients. Neither associated disorders (rectocoele, rectal prolapse, abnormal perineal descent, anal pressure and abnormalities of rectal sensation) nor a relevant past history (hysterectomy, laxative abuse, use of antidepressive agents) were encountered more frequently in these 13 patients than in the other 14. The duration of symptoms before treatment was significantly longer in the group unresponsive to biofeedback retraining (81 +/- 61 compared with 33 +/- 34 months for the responsive group, P < 0.01), but the total duration of symptoms and the number of retraining sessions attended did not differ significantly between the two groups.
(1) Extensive examination (defecography and manometry) before biofeedback retraining of anismus is not mandatory because the failure of retraining (48%) is not related to the presence of associated pelvirectal disorders. (2) A long past history of dyschezia seems to provide an index of the failure of biofeedback retraining.
生物反馈是治疗盆底失弛缓综合征患者排便困难的主要方法，但由于盆底直肠疾病常与盆底失弛缓综合征并存，再训练可能会失败。我们旨在确定盆底失弛缓综合征治疗中生物反馈失败的指标。
1990年5月至1993年5月，27例（20例女性，7例男性；中位年龄46岁）盆底失弛缓综合征患者纳入生物反馈再训练项目，这些患者使用缓泻剂后排便困难未改善。所有患者均接受直肠检查、肛门测压和排粪造影。盆底失弛缓综合征定义为排便时肛门压力增加，同时使用客观测试（钡糊排出试验）评估直肠排空功能受损。常伴有其他相关疾病，包括会阴下降异常（22例）、巨大直肠膨出（12例）、重度直肠脱垂（6例）、静息时肛管压力异常增高（7例）以及直肠对充气的异常反应（20例）。若不考虑会阴下降、轻度脱垂和直肠感觉异常，12例患者仅有盆底失弛缓综合征这一异常。
27例患者中，13例生物反馈再训练未能抑制排便困难。这13例患者与另外14例患者相比，相关疾病（直肠膨出、直肠脱垂、会阴下降异常、肛门压力和直肠感觉异常）及相关既往史（子宫切除术、滥用缓泻剂、使用抗抑郁药）的发生率并无差异。生物反馈再训练无反应组治疗前症状持续时间显著更长（81±61个月，而反应组为33±34个月，P<0.01），但两组症状总持续时间和接受再训练的次数并无显著差异。
（1）盆底失弛缓综合征生物反馈再训练前无需进行全面检查（排粪造影和测压），因为再训练失败率（48%）与盆底直肠相关疾病的存在无关。（2）排便困难病史较长似乎提示生物反馈再训练可能失败。
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