Papachrysostomou M, Pye S D, Wild S R, Smith A N
Dept. of Gastroenterology, University of Edinburgh, Western General Hospital, UK.
Scand J Gastroenterol. 1994 Aug;29(8):710-4. doi: 10.3109/00365529409092498.
Ultrasonographic studies in healthy volunteers showed that the external anal sphincter (EAS) and internal anal sphincter (IAS) thicknesses were inversely related at rest. The functional importance of the two sphincters in continence control was demonstrated in the relationship between the sum of the thicknesses of the two sphincters and the anal canal resting pressure. The aims of the present study were to assess the morphometric appearance of the anal sphincters by endosonography in faecally incontinent patients and to contrast this with that of older healthy subjects.
Twenty-eight female patients with neurogenic faecal incontinence (FI) were studied. An older group of 7 healthy women, aged 41-75 years, and a young group of 11 nulliparous healthy women, aged 20-23 years, served as control groups. Anal endosonography was performed with a radial rotating endoprobe, with the subject in the left lateral position. Conventional anal manometry was performed in all subjects.
The EAS in the FI group was thicker than the EAS in the old (p < 0.04) but did not differ from the EAS in the young. The IAS thickness in the FI group did not differ from that in the older group. In both these groups the IAS was thicker than in the young women (p < 0.01). The anal pressures in the FI group were reduced compared with the normal groups (p < 0.04). There was a direct relationship between the two sphincters in FI (p < 0.001).
The increased thickness of the IAS in the FI group does not seem to compensate for function and results in a failure of the sphincter mechanism to maintain continence, whereas in healthy elderly subjects the increased IAS thickness appears to be compensatory and important for continence control.
对健康志愿者的超声检查显示，静息状态下肛门外括约肌（EAS）和肛门内括约肌（IAS）的厚度呈负相关。两种括约肌在控便功能中的重要性通过两种括约肌厚度之和与肛管静息压力之间的关系得以体现。本研究的目的是通过内镜超声评估大便失禁患者肛门括约肌的形态学表现，并与老年健康受试者进行对比。
对28例神经源性大便失禁（FI）女性患者进行了研究。一组年龄在41 - 75岁的7名健康老年女性和一组年龄在20 - 23岁的11名未生育健康年轻女性作为对照组。受试者取左侧卧位，使用径向旋转式内镜探头进行肛门内镜超声检查。所有受试者均进行了常规肛门测压。
FI组的EAS比老年组的EAS厚（p < 0.04），但与年轻组的EAS无差异。FI组的IAS厚度与老年组无差异。在这两组中，IAS均比年轻女性厚（p < 0.01）。与正常组相比，FI组的肛门压力降低（p < 0.04）。FI组中两种括约肌之间存在直接关系（p < 0.001）。
FI组中IAS厚度增加似乎并未补偿功能，导致括约肌机制无法维持控便，而在健康老年受试者中，IAS厚度增加似乎具有代偿作用且对控便很重要。
