Pezim M E, Pemberton J H, Levin K E, Litchy W J, Phillips S F
Gastroenterology Research Unit, Mayo Clinic, Rochester, Minnesota 55905.
Dis Colon Rectum. 1993 May;36(5):484-91. doi: 10.1007/BF02050015.
Anorectal function and colonic transit was assessed in 17 severely constipated patients and 15 age-matched controls. The constipated patients were divided into those who had "immobile perineum" (perineal descent < or = 1.0 cm during attempted defecation) and those who had a normal descent (> 1.0 cm) of the perineum. When constipation was accompanied by an immobile perineum, patients had impaired balloon expulsion, impaired and delayed artificial stool expulsion, decreased straightening of the anorectal angle, decreased descent of the pelvic floor with defecation, and prolonged rectosigmoid colon transit compared with the patients with constipation who had a mobile perineum and with normal controls. The mobile-perineum group differed from controls only in colon transit times, having prolonged total colon transit. Anal sphincter resting pressures, immediate artificial stool expulsion, resting anorectal angles, and electromyography of the external anal sphincter and puborectalis did not differentiate the constipated patients from the controls. We concluded that descent of the perineum of < 1 cm was associated with impaired expulsion, an adynamic anorectal angle, and slowed distal colon transit. This simple sign of pelvic floor function distinguished constipated patients with disordered expulsion from constipated patients with normal pelvic floor function. These patients may respond poorly to surgery and conventional management and would therefore be candidates instead for pelvic floor retraining. Accurate characterization and appreciation of pelvic floor dysfunction in patients with severe chronic constipation may improve the selection for and results of surgical and nonsurgical intervention.
对17名严重便秘患者和15名年龄匹配的对照者进行了肛门直肠功能和结肠传输评估。便秘患者被分为“会阴固定”（排便时会阴下降≤1.0 cm）和会阴下降正常（>1.0 cm）两组。当便秘伴有会阴固定时，与会阴可活动的便秘患者及正常对照者相比，患者的球囊排出功能受损、人工排便功能受损且延迟、肛门直肠角变直减少、排便时盆底下降减少以及直肠乙状结肠传输时间延长。会阴可活动组与对照组仅在结肠传输时间上存在差异，其全结肠传输时间延长。肛门括约肌静息压力、即刻人工排便、静息肛门直肠角以及肛门外括约肌和耻骨直肠肌的肌电图检查并不能区分便秘患者和对照组。我们得出结论，会阴下降<1 cm与排出功能受损、肛门直肠角动力不足以及远端结肠传输减慢有关。这个简单的盆底功能指标可区分排出功能紊乱的便秘患者和盆底功能正常的便秘患者。这些患者可能对手术和传统治疗反应不佳，因此可能适合进行盆底功能再训练。准确描述和认识严重慢性便秘患者的盆底功能障碍可能会改善手术和非手术干预的选择及效果。
