神经源性大便失禁中的内括约肌功能障碍
Internal anal sphincter dysfunction in neurogenic faecal incontinence.
作者信息
Farouk R, Duthie G S, Pryde A, McGregor A B, Bartolo D C
机构信息
Department of Surgery, Royal Infirmary, Edinburgh, UK.
出版信息
Br J Surg. 1993 Feb;80(2):259-61. doi: 10.1002/bjs.1800800250.
Forty-eight patients of median age 57 years with neurogenic faecal incontinence and 44 normal subjects of median age 51 years underwent fine-wire anal sphincter electromyography and anal manometry. The median (interquartile range (i.q.r.)) internal anal sphincter (IAS) electromyogram frequency was 0.26 (0.21-0.32) Hz for patients with faecal incontinence and 0.44 (0.31-0.55) Hz for controls (P < 0.01). The median (i.q.r.) ambulatory resting pressure was 48 (34-68) cmH2O for patients and 86 (72-102) cmH2O for controls (P < 0.01) and median (i.q.r.) frequency of transient IAS relaxations 9 (7-12) and 4 (3-7) per h respectively (P < 0.05). Mid-anal pressure fell to a greater extent in patients with incontinence during these episodes of transient IAS relaxation. Rectal pressure during such relaxation did not exceed mid-anal canal pressure in controls; for the patient group, rectal pressure increased during relaxation and exceeded mid-anal canal pressure in 36 cases. Frequent abnormal episodes of IAS relaxation may cause occult faecal leakage in patients with neurogenic faecal incontinence.
48名中位年龄为57岁的神经源性大便失禁患者和44名中位年龄为51岁的正常受试者接受了细针肛门括约肌肌电图检查和肛门测压。大便失禁患者的肛门内括约肌（IAS）肌电图频率中位数（四分位间距（i.q.r.））为0.26（0.21 - 0.32）Hz，对照组为0.44（0.31 - 0.55）Hz（P < 0.01）。患者的动态静息压力中位数（i.q.r.）为48（34 - 68）cmH₂O，对照组为86（72 - 102）cmH₂O（P < 0.01），IAS短暂松弛的频率中位数（i.q.r.）分别为每小时9（7 - 12）次和4（3 - 7）次（P < 0.05）。在这些IAS短暂松弛发作期间，失禁患者的肛管中部压力下降幅度更大。对照组在这种松弛过程中直肠压力不超过肛管中部压力；对于患者组，松弛过程中直肠压力升高，36例患者超过肛管中部压力。IAS频繁异常松弛发作可能导致神经源性大便失禁患者隐匿性粪便泄漏。
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