Jorge J M, Wexner S D, Ehrenpreis E D, Nogueras J J, Jagelman D G
Department of Colorectal Surgery, Cleveland Clinic Florida, Fort Lauderdale 33309.
Dis Colon Rectum. 1993 May;36(5):475-83. doi: 10.1007/BF02050014.
A prospective study was undertaken to assess the potential correlation between increased perineal descent (IPD) and pudendal neuropathy (PN) in 213 consecutive patients. These 165 females and 48 males of a mean age of 62 (range, 18-87) years had constipation (n = 115), idiopathic fecal incontinence (n = 58), or chronic intractable rectal pain (n = 40). All 213 patients underwent cinedefecography (CD) and bilateral pudendal nerve terminal motor latency (PNTML) assessment. Perineal descent (PD) of more than the upper limit of normal of 3.0 cm during evacuation was considered increased. Pudendal neuropathy was diagnosed when PNTML exceeded the upper limit of normal of 2.2 milliseconds. Although 65 patients (31 percent) had PD, only 16 (25 percent) of these 65 patients had neuropathy. Moreover, PN was also found in 42 (28 percent) of 148 patients without IPD. Conversely, only 16 (28 percent) of the 58 patients who had PN also had IPD, and IPD was present in 49 (32 percent) of 155 patients without PN. The frequency of PN according to the degree of IPD was: 3.0 to 4.0 cm, 6 of 27 patients (22 percent); 4.1 to 5.0 cm, 4 of 15 (27 percent); 5.1 to 6.0 cm, 4 of 12 (25 percent); 6.1 to 7.0 cm, 2 of 8 (25 percent); and > 7.0 cm, 0 of 3 (0 percent). Linear regression analysis was undertaken to compare the relationships between measurements of PD at rest (R), push (P), and change (C = P-R) and values of PNTML. These values for all 213 patients were: R, r = 0.048; P, r = 0.031; and C, r = -0.050. The correlation coefficients were equally poor for all the individual subgroups analyzed, including the patient's sex or diagnosis. In summary, no correlation was found between PD and PNTML. The lack of a relationship was seen for the entire group as well as for those patients with either neuropathy or increased perineal descent. Therefore, the often espoused relationship between increased PD and PN was not supported by this prospective evaluation. Although increased PD and prolonged PNTML are frequently observed in patients with disordered defecation, they may represent independent findings.
对213例连续患者进行了一项前瞻性研究，以评估会阴下降增加（IPD）与阴部神经病变（PN）之间的潜在相关性。这165名女性和48名男性的平均年龄为62岁（范围18 - 87岁），患有便秘（n = 115）、特发性大便失禁（n = 58）或慢性顽固性直肠疼痛（n = 40）。所有213例患者均接受了排粪造影（CD）和双侧阴部神经终末运动潜伏期（PNTML）评估。排便时会阴下降（PD）超过正常上限3.0 cm被认为是增加。当PNTML超过正常上限2.2毫秒时诊断为阴部神经病变。虽然65例患者（31%）有PD，但这65例患者中只有16例（25%）有神经病变。此外，在148例无IPD的患者中也发现42例（28%）有PN。相反，58例有PN的患者中只有16例（28%）也有IPD，155例无PN的患者中有49例（32%）有IPD。根据IPD程度的PN发生率为：3.0至4.0 cm，27例患者中有6例（22%）；4.1至5.0 cm，15例中有4例（27%）；5.1至6.0 cm，12例中有4例（25%）；6.1至7.0 cm，8例中有2例（25%）；> 7.0 cm，3例中有0例（0%）。进行线性回归分析以比较静息时（R）、用力时（P）的PD测量值以及变化值（C = P - R）与PNTML值之间的关系。所有213例患者的这些值为：R，r = 0.048；P，r = 0.031；C，r = -0.050。在分析的所有个体亚组中，包括患者的性别或诊断，相关系数同样很差。总之，未发现PD与PNTML之间存在相关性。在整个组以及有神经病变或会阴下降增加的患者中均未发现这种关系。因此，这种前瞻性评估不支持经常所主张的PD增加与PN之间的关系。虽然在排便障碍患者中经常观察到PD增加和PNTML延长，但它们可能是独立的发现。
