Varma J S, Binnie N R, Kawimbe B, Papachrysostomou M, Smith A N
University Department of Surgery, Western General Hospital, Edinburgh, UK.
Int J Colorectal Dis. 1993 Jul;8(2):66-70. doi: 10.1007/BF00299329.
The activities of a regional physiology unit established for the investigation of colorectal and pelvic floor physiology in health and disease in a clinically relevant setting has been audited and its evolution described over a period of eight years. Trends in surgical treatment of some of these disorders over the same period have also been documented in the Lothian Region. Although there has been little change in the number of patients investigated annually patterns of investigation appear to change. Sphincter manometry, proctometrography and somatosensory reflex measurements have remained the most frequently performed and useful investigations. Spinal stimulation studies increased transiently because of a collaborative investigation of bowel and bladder function in patients with spinal injuries. A considerable increase in surface EMG tests and dynamic proctography has occurred. These trends are thought to be related to interest in defining evacuation dysfunction of the rectum and related problems of the pelvic floor. Isotope proctography now rivals barium videoproctography; at the same time the use of manometric colonic motility studies has diminished. Anal ultrasonography has replaced sphincter mapping in the last year and is being applied to other aspects of anorectal pathology. The last 4 years have seen the introduction and increasing use of non-surgical therapeutic modalities for the treatment of faecal incontinence and constipation: reflex electronic sphincter stimulation, biofeedback and the use of a prokinetic agent to promote colonic motility. Concomitant changes in the surgery of constipation and reconstructive anorectal procedures have been observed. It is recommended that coloproctology units should have easy access to at least one such investigation laboratory within their catchment area together with appropriate auditing facilities.
已对一个在临床相关环境中设立的区域生理学单位的活动进行了审计，该单位旨在研究健康和疾病状态下的结直肠及盆底生理学，并描述了其在八年时间里的发展情况。同期洛锡安地区也记录了其中一些疾病的外科治疗趋势。尽管每年接受检查的患者数量变化不大，但检查模式似乎有所改变。括约肌测压、直肠测压造影和躯体感觉反射测量仍然是最常进行且最有用的检查。由于对脊髓损伤患者的肠道和膀胱功能进行了合作研究，脊髓刺激研究曾短暂增加。表面肌电图测试和动态直肠造影有了显著增加。这些趋势被认为与对定义直肠排空功能障碍及盆底相关问题的兴趣有关。同位素直肠造影现在可与钡剂视频直肠造影相媲美；与此同时，压力测定结肠动力研究的使用有所减少。去年，肛门超声检查已取代括约肌绘图，并正应用于肛门直肠病理学的其他方面。在过去4年里，出现了用于治疗大便失禁和便秘的非手术治疗方式并越来越多地被使用：反射性电子括约肌刺激、生物反馈以及使用促动力剂促进结肠动力。同时，观察到便秘手术和重建性肛门直肠手术也有相应变化。建议结肠直肠病科在其服务区域内至少应能方便地使用一个这样的检查实验室以及适当的审计设施。
