Solana A, Roig J V, Villoslada C, Hinojosa J, Lledo S
Department of General and Digestive Surgery, Sagunto Hospital, Valencia, Spain.
Int J Colorectal Dis. 1996;11(2):65-70. doi: 10.1007/BF00342462.
Patients with obstructed defaecation (OD) perform major defaecatory efforts that lead progressively to pudendal motor neuropathy. Anorectal sensory function in these patients and its possible influence in the pathogenesis of the disease have been little studied. In the present paper we investigated anorectal sensitivity to electric and thermal stimuli in patients with OD, and studied the possible existence of pudendal sensory neuropathy associated to their known pudendal motor neuropathy. Forty subjects were divided into two groups: 21 healthy controls (11 females and 10 males; mean age 51.8 +/- 11 years, range 33-67) and 19 patients with OD (18 females and 1 male; mean age 48 +/- 15 years, range 20-71). The patients with OD suffered constipation and an obstruction sensation upon defaecating, even in the case of soft stools. Clinical perineometry, manometry, pudendal motor latency studies, external anal sphincter single fibre electromyography and the evaluation of sensitivity to electric and thermal stimuli were carried out in all cases. All pudendal motor function parameters showed statistically significant differences between the two groups. In the controls the electrical sensitivity threshold was minimal in the mid anal canal, where sensory receptor presence is greater. Sensitivity was significantly higher in the upper and lower anal canal regions (P < 0.05), and much higher in the rectum (P < 0.001). A similar sensory profile was recorded in the patients with OD, though with significantly higher thresholds at all points with respect to the controls. The thermal stimulus thresholds in the lower and middle anal canal were significantly smaller than in the upper canal region and rectum, and the thresholds were again higher among the patients with OD than among the controls. In all cases the thresholds for heat were lower than for cold stimuli. In both groups the motor function parameters were correlated with the sensory function variables, and the latter between themselves. Patients with OD presented sensory deterioration at all points studied in the anal canal and rectum. Sensory pudendal neuropathy was found to be associated with the pudental motor neuropathy.
排便梗阻（OD）患者为排出大便需付出巨大努力，这会逐渐导致阴部运动神经病变。这些患者的肛门直肠感觉功能及其在疾病发病机制中的可能影响鲜有研究。在本文中，我们研究了OD患者对电刺激和热刺激的肛门直肠敏感性，并探讨了与其已知的阴部运动神经病变相关的阴部感觉神经病变的可能存在情况。40名受试者分为两组：21名健康对照者（11名女性和10名男性；平均年龄51.8±11岁，范围33 - 67岁）和19名OD患者（18名女性和1名男性；平均年龄48±15岁，范围20 - 71岁）。OD患者即使在大便松软的情况下也会出现便秘和排便时有梗阻感。所有病例均进行了临床会阴测压、压力测定、阴部运动潜伏期研究、肛门外括约肌单纤维肌电图检查以及对电刺激和热刺激的敏感性评估。两组之间所有阴部运动功能参数均显示出统计学上的显著差异。在对照组中，肛管中部的电敏感性阈值最低，此处感觉受体较多。肛管上部和下部区域的敏感性显著更高（P < 0.05），而直肠的敏感性则高得多（P < 0.001）。OD患者也记录到了类似的感觉特征，不过与对照组相比，所有部位的阈值均显著更高。肛管下部和中部的热刺激阈值明显低于肛管上部区域和直肠，且OD患者的阈值再次高于对照组。在所有情况下，热刺激的阈值均低于冷刺激的阈值。两组中的运动功能参数均与感觉功能变量相关，且感觉功能变量之间也相互关联。OD患者在肛管和直肠的所有研究部位均出现感觉减退。发现阴部感觉神经病变与阴部运动神经病变相关。
