Morgado P J, Wexner S D, James K, Nogueras J J, Jagelman D G
Department of Colorectal Surgery, Cleveland Clinic Florida, Fort Lauderdale 33309.
Dis Colon Rectum. 1994 Mar;37(3):224-8. doi: 10.1007/BF02048159.
The aim of this study was to determine the value of preoperative anal manometry in predicting post-operative continence.
Anal manometry was performed in 73 consecutive patients before ileal pouch-anal anastomosis (IPAA) surgery (m1), before loop ileostomy closure (m2), and at a follow-up of one (m3) and two (m4) years. Mean and maximum resting and squeezing pressures were documented at each occasion. One year after surgery, pressures were correlated (r) with an incontinence score.
A significant (P < 0.05) decrease in mean resting pressures was observed after IPAA (m1 = 66 mmHg; m2 = 42.8 mmHg), followed by a significant (P < 0.05) improvement of mean resting pressure after loop ileostomy closure (m3 = 53.8 mmHg; m4 = 54.7 mmHg). Mean squeezing pressures did not change (P > 0.05) at any time during the study (m1 = 114 mmHg; m2 = 102.9 mmHg; m3 = 103.4 mmHg; m4 = 95.8 mmHg). There was no correlation between preoperative mean resting pressure and postoperative (mI) incontinence score.
Anal manometry showed a characteristic trend in internal anal sphincter injury after IPAA followed by recovery after ileostomy closure. However, it failed to prove helpful in the prediction of clinical outcome. Thus, although this study supports the continued use of manometry in a research setting, it challenges the value of routine manometry in a clinical context.
本研究旨在确定术前肛门测压在预测术后控便能力方面的价值。
对73例连续患者在回肠贮袋肛管吻合术（IPAA）手术前（m1）、回肠造口关闭前（m2）以及术后1年（m3）和2年（m4）进行肛门测压。每次记录平均和最大静息及收缩压。术后1年，将压力与失禁评分进行相关性（r）分析。
IPAA术后平均静息压显著降低（P < 0.05）（m1 = 66 mmHg；m2 = 42.8 mmHg），随后回肠造口关闭后平均静息压显著改善（P < 0.05）（m3 = 53.8 mmHg；m4 = 54.7 mmHg）。在研究期间，平均收缩压在任何时候均无变化（P > 0.05）（m1 = 114 mmHg；m2 = 102.9 mmHg；m3 = 103.4 mmHg；m4 = 95.8 mmHg）。术前平均静息压与术后（mI）失禁评分之间无相关性。
肛门测压显示IPAA术后肛门内括约肌损伤呈现特征性趋势，随后在回肠造口关闭后恢复。然而，它未能证明对预测临床结局有帮助。因此，尽管本研究支持在研究环境中继续使用测压法，但它对临床常规测压的价值提出了挑战。
