Wexner S D, Jorge J M
Department of Colorectal Surgery, Cleveland Clinic Florida, Fort Lauderdale, Florida.
Eur J Surg. 1994 Mar;160(3):167-74.
To assess the value of colorectal physiological tests in patients with functional disorders of defecation.
Prospective study.
Academic hospital.
308 consecutive patients.
Routine history and physical examination, followed by colonic transit study, and manometry, cinedefecography, electromyography of the anal sphincter, and assessment of terminal motor latency of the pudendal nerve.
Number of diagnoses made after physiological tests compared with routine history and examination alone.
Definitive diagnoses were made after history and physical examination alone in 15/180 (8%) with constipation, 9/80 (11%) with incontinence, and 11/48 (23%) with intractable rectal pain. The figures after physiological tests were 135/180 (75%), 53/80 (66%), and 20/48 (42%), respectively. Among the diagnoses made by physiological testing alone were: in patients with constipation, paradoxical puborectalis contraction (n = 59), colonic inertia (n = 31), rectocele (n = 19), and intussusception (n = 18); in those with incontinence, loss of muscle fiber (n = 21), neuropathy (n = 10), and both (n = 15); and in those with rectal pain, neuropathy (n = 6) and paradoxical puborectalis contraction (n = 3). The numbers of patients that remained undiagnosed in the three groups were 45 (25%), 27 (34%), and 28 (58%), respectively. Treatable conditions were diagnosed by physiological testing in 120/180 patients with constipation (67%) and 44 patients with incontinence (55%). Only 9 patients with rectal pain had treatable causes identified by physiologic testing.
The value of colorectal physiological tests is greatest in patients who present with constipation or incontinence; they are of little value in those with chronic intractable rectal pain.
评估结直肠生理检查在排便功能障碍患者中的价值。
前瞻性研究。
教学医院。
308例连续患者。
进行常规病史采集和体格检查，随后进行结肠传输试验、测压、排粪造影、肛门括约肌肌电图检查以及阴部神经终末运动潜伏期评估。
与仅进行常规病史采集和体格检查相比，生理检查后做出诊断的数量。
仅通过病史采集和体格检查，便秘患者中确诊的有15/180例（8%），大便失禁患者中确诊的有9/80例（11%），顽固性直肠疼痛患者中确诊的有11/48例（23%）。生理检查后的相应数字分别为135/180例（75%）、53/80例（66%）和20/48例（42%）。仅通过生理检查做出的诊断包括：便秘患者中，耻骨直肠肌反常收缩（n = 59）、结肠无力（n = 31）、直肠膨出（n = 19）和肠套叠（n = 18）；大便失禁患者中，肌纤维丧失（n = 21）、神经病变（n = 10）以及两者皆有（n = 15）；直肠疼痛患者中，神经病变（n = 6）和耻骨直肠肌反常收缩（n = 3）。三组中仍未确诊的患者数量分别为45例（25%）、27例（34%）和28例（58%）。120/180例便秘患者（67%）和44例大便失禁患者（55%）通过生理检查诊断出了可治疗的疾病。只有9例直肠疼痛患者通过生理检查确定了可治疗的病因。
结直肠生理检查在便秘或大便失禁患者中的价值最大；在慢性顽固性直肠疼痛患者中价值不大。
