Farouk R, Duthie G S, MacGregor A B, Bartolo D C
Department of Surgery, Royal Infirmary of Edinburgh, Scotland, United Kingdom.
Dis Colon Rectum. 1994 May;37(5):424-9. doi: 10.1007/BF02076185.
This study was designed to determine whether functional variations of internal sphincter activity occur in order to differentiate between patients with anal fissures from those with hemorrhoids.
Thirty patients with chronic anal fissure (median age, 28 years; 12 females), 22 patients with hemorrhoids (median age, 37 years; 7 females), and 33 control volunteers (median age, 48.5 years; 21 females) underwent ambulatory anal sphincter fine-needle electromyography and anorectal manometry.
The median internal sphincter electromyography frequency was similar: fissure group, 0.49 Hz; hemorrhoid group, 0.46 Hz (P > 0.05), and control group, 0.44 Hz (P > 0.05). Median anal resting pressures were similar in the fissure group (132 cm. H2O) and the hemorrhoids group (116 cm of H2O) (P > 0.05), but significantly greater than those in the control group (94 cm. H2O) (P < 0.05). The median number of transient relaxations of the internal and sphincter with an associated rise in rectal pressure and fall in anal pressure was 1 (range, 0-4) per hour in the fissure group, 6 (range, 4-7) per hour in the hemorrhoid group, and 4 range, 3-6) per hour in the control group. Six patients with fissures were reassessed following lateral internal sphincterotomy. Median and pressure was 102 cm of H2O (P > 0.1 vs. controls) and the number of internal sphincter relaxations increased to 4 per hour (P < 0.01 vs. preoperative number).
Internal anal sphincter relaxation occurs on fewer occasions in patients with chronic anal fissures that have failed to heal in comparison to patients with hemorrhoids and normal controls. This evidence further supports the hypothesis that internal sphincter hypertonia may be relevant to the pathogenesis of this disorder.
本研究旨在确定内括约肌活动的功能变化是否存在，以区分肛裂患者与痔疮患者。
30例慢性肛裂患者（中位年龄28岁；女性12例）、22例痔疮患者（中位年龄37岁；女性7例）和33名对照志愿者（中位年龄48.5岁；女性21例）接受了动态肛门括约肌细针肌电图检查和肛肠测压。
内括约肌肌电图频率中位数相似：肛裂组为0.49Hz；痔疮组为0.46Hz（P>0.05），对照组为0.44Hz（P>0.05）。肛裂组（132cmH₂O）和痔疮组（116cmH₂O）的肛门静息压中位数相似（P>0.05），但显著高于对照组（94cmH₂O）（P<0.05）。肛裂组内括约肌和直肠压力相关的瞬时松弛中位数为每小时1次（范围0-4次），痔疮组为每小时6次（范围4-7次），对照组为每小时4次（范围3-6次）。6例肛裂患者在内括约肌侧切术后接受了重新评估。静息压中位数为102cmH₂O（与对照组相比P>0.1），内括约肌松弛次数增加至每小时4次（与术前次数相比P<0.01）。
与痔疮患者和正常对照相比，慢性肛裂未愈合患者内括约肌松弛的情况较少。这一证据进一步支持了内括约肌张力过高可能与该疾病发病机制相关的假说。
