Sangwan Y P, Coller J A, Schoetz D J, Roberts P L, Murray J J
Department of Colon and Rectal Surgery, Lahey Clinic, Burlington, Massachusetts 01805, USA.
Dis Colon Rectum. 1996 Jan;39(1):59-65. doi: 10.1007/BF02048271.
Abnormalities of rectoanal inhibitory or excitatory reflex in patients with fecal incontinence are well described. A spectrum of abnormal responses, other than those already described in the literature, has been observed in some patients with fecal incontinence and forms the subject of this report.
Forty-three patients with idiopathic or traumatic fecal incontinence were studied to evaluate their reflex responses to balloon distention of the rectum, and results were compared with reflex responses of 29 control subjects with no anorectal complaints.
Control subjects revealed normal reflex responses consisting of initial excitation followed by inhibition in the proximal anal canal and an excitatory response in the distal anal canal. Patients who were incontinent revealed five different types of reflex patterns. Eleven patients (25.5 percent) with segmental sphincter defects from obstetric injuries exhibited no distal excitation but had normal response in the proximal anal canal (Group 1). Eleven patients (25.5 percent) with idiopathic incontinence exhibited normal proximal response but an inhibitory as opposed to excitatory response in the distal anal canal (Group 2). Three patients (7 percent) with iatrogenic trauma failed to register an excitatory response in the proximal or distal anal canal but revealed a normal inhibitory reflex (Group 3). Nine patients (21 percent) with idiopathic incontinence revealed excitatory response in the entire anal canal but no inhibition (Group 4). Nine patients (21 percent) with idiopathic incontinence had a normal reflex pattern (Group 5).
Excitatory and inhibitory components of rectoanal reflexes may selectively be abolished in neurogenic or traumatic insults to visceral and somatic anal sphincters, resulting in altered rectoanal reflex patterns.
大便失禁患者的直肠肛门抑制或兴奋反射异常已有详尽描述。在一些大便失禁患者中观察到了一系列文献中尚未描述的异常反应，本报告以此为主题。
对43例特发性或创伤性大便失禁患者进行研究，以评估其对直肠气囊扩张的反射反应，并将结果与29例无肛肠疾病主诉的对照受试者的反射反应进行比较。
对照受试者表现出正常的反射反应，即近端肛管先兴奋后抑制，远端肛管有兴奋反应。失禁患者表现出五种不同类型的反射模式。11例（25.5%）因产科损伤导致节段性括约肌缺陷的患者，远端无兴奋反应，但近端肛管反应正常（第1组）。11例（25.5%）特发性失禁患者近端反应正常，但远端肛管为抑制而非兴奋反应（第2组）。3例（7%）医源性创伤患者近端或远端肛管均未记录到兴奋反应，但抑制反射正常（第3组）。9例（21%）特发性失禁患者整个肛管均有兴奋反应，但无抑制（第4组）。9例（21%）特发性失禁患者反射模式正常（第5组）。
在内脏和躯体肛门括约肌的神经源性或创伤性损伤中，直肠肛门反射的兴奋和抑制成分可能被选择性消除，导致直肠肛门反射模式改变。
