Sielezneff I, Sarles J C, Sastre B
Service de Chirurgie générale et digestive, Hôpital Sainte-Marguerite, Marseille.
Presse Med. 1994 Nov 26;23(37):1691-4.
Anorectal asynchronism is a frequent and unrecognized cause of terminal constipation. The aim of this study was to describe clinical and instrumental findings, and results of biofeedback therapy.
From 1987 to 1991, 18 patients with anorectal asynchronism were studied then treated by biofeedback training.
We found high rates of pelvic and perineal trauma (77.7%), of psychogenic factors (6.5%), of urinary incontinence (27.8%). The manometrical study confirmed puborectalis paradoxical contraction during defecation straining, and all the patients could not expel a rectal balloon containing 50 ml of air; non-specific manometrical abnormality was found in 44.5% patients. Excessive stamp of puborectalis muscle was always found at defecography; 77.7% of the patients had incomplete rectal evacuation, and 61.1% had an associated pelvic floor disorder. Biofeedback training was successful, and 88.9% of the patients were cured by 5 or 6 sessions. There was no predictive parameter in our study, but recovery rate seemed to be lower for patients from 45 to 55 years old.
The diagnosis of the anorectal asynchronism is easily made with manometry and defecography. Treatment with biofeedback gives very good results in almost all patients.
肛门直肠不同步是导致终末期便秘的常见但未被认识的原因。本研究旨在描述临床和器械检查结果以及生物反馈治疗的效果。
1987年至1991年，对18例肛门直肠不同步患者进行研究，然后采用生物反馈训练进行治疗。
我们发现骨盆和会阴创伤发生率高（77.7%）、心理因素发生率（6.5%）、尿失禁发生率（27.8%）。压力测量研究证实排便用力时耻骨直肠肌反常收缩，所有患者均无法排出装有50毫升空气的直肠气囊；44.5%的患者存在非特异性压力测量异常。排便造影时总能发现耻骨直肠肌过度压迫；77.7%的患者直肠排空不完全，61.1%的患者伴有盆底功能障碍。生物反馈训练取得成功，88.9%的患者经5或6次治疗后治愈。本研究中没有预测参数，但45至55岁患者的治愈率似乎较低。
通过压力测量和排便造影可轻松诊断肛门直肠不同步。生物反馈治疗在几乎所有患者中都能取得很好的效果。
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