Ferrara A, Pemberton J H, Levin K E, Hanson R B
Section of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota 55905.
Dis Colon Rectum. 1993 Apr;36(4):337-42. doi: 10.1007/BF02053935.
The anal sphincters facilitate fecal continence by maintaining a pressure barrier; whether proximal contractile events influence this barrier is unknown. The aim of this study was to determine whether a relationship exists between anal canal pressures and rectal motor activity. A fully ambulatory system for prolonged pressure recording was developed. In 12 healthy subjects (seven males and five females; mean age, 35 years; range, 22-43 years), a flexible transducer catheter (outside diameter, 4.5 mm) was introduced endoscopically such that sensors were 2, 3, 8, 12, 18, and 24 cm from the anal orifice. Twenty-four-hour spontaneous motor activity was stored in a 2.5-megabyte portable recorder for later transfer to a Microvax II for computerized analysis and display. Mean anal canal pressure was calculated, and rectal motor complexes (RMCs) were characterized. Mean and canal resting pressure was 75 +/- 12 mmHg. During sleep, anal pressures displayed cyclic decreases (mean periodicity, 1.6 hours; range, 1-4 hours), during which the mean +/- SD pressure trough was 15 +/- 4 mmHg (range, 8-21 mmHg). RMCs were identified in all subjects: mean frequency, 16 per 24 hours (range, 12-22 per 24 hours); duration, 15.3 minutes (range, 8-35 minutes); contractile frequency, two to three per minute; mean peak amplitudes, 58 +/- 18 mmHg; and periodicity, 78 +/- 24 minutes (range, 35-265 minutes). Importantly, an RMC was invariably accompanied by a rise in mean anal canal pressure and contractile activity such that pressure in the anal canal was always greater than pressure in the rectum. Anal canal relaxations never occurred during an RMC. Motor activities of the rectum and of the anal canal may be related; the onset of rectal contractions was accompanied by increased resting pressure and contractile activity of the anal canal. This temporal relationship represents an important mechanism preserving fecal continence.
肛门括约肌通过维持压力屏障来促进粪便节制；近端收缩事件是否影响这一屏障尚不清楚。本研究的目的是确定肛管压力与直肠运动活动之间是否存在关联。开发了一种用于长时间压力记录的完全可移动系统。在12名健康受试者（7名男性和5名女性；平均年龄35岁；范围22 - 43岁）中，通过内镜插入一根柔性换能器导管（外径4.5毫米），使传感器距离肛门开口2、3、8、12、18和24厘米。24小时的自发运动活动存储在一个2.5兆字节的便携式记录器中，随后传输到Microvax II进行计算机分析和显示。计算平均肛管压力，并对直肠运动复合体（RMCs）进行特征描述。平均肛管静息压力为75±12毫米汞柱。在睡眠期间，肛管压力呈现周期性下降（平均周期为1.6小时；范围1 - 4小时），在此期间，平均±标准差压力谷值为15±4毫米汞柱（范围8 - 21毫米汞柱）。在所有受试者中均识别出RMCs：平均频率为每24小时16次（范围每24小时12 - 22次）；持续时间为15.3分钟（范围8 - 35分钟）；收缩频率为每分钟2 - 3次；平均峰值幅度为58±18毫米汞柱；周期性为78±24分钟（范围35 - 265分钟）。重要的是，一次RMC总是伴随着平均肛管压力和收缩活动的升高，使得肛管内压力始终大于直肠内压力。在RMC期间从未发生肛管松弛。直肠和肛管的运动活动可能相关；直肠收缩的开始伴随着肛管静息压力和收缩活动的增加。这种时间关系代表了维持粪便节制的一种重要机制。
