Arsac M, Bouchoucha M
Laboratoire de Physiologie-Hôpital Laennec, Paris.
Bull Acad Natl Med. 1996 Apr;180(4):747-64; discussion 765-8.
We have developed an original method of determining the rectal and the anal compliance. The rectum must serve as a fecal reservoir. This storage function requires that the rectum must be distensible. The anal canal must become easily looser for defecation. These features are not explored by the usual rectoanal manometric recordings. Very few investigations about the compliance are carried out. In our procedure, exploration balloons are connected via polyethylene tubes to pressure transducers, direct-writing electrical recorder and pump under the command of the computer. The pressure generated is as high as the distensibility is poor, as the compliance is decreased. The pressure/volume curve shows the compliance. The procedure is different for the rectum on the one hand, and for the anal canal on the other. The rectal device consists of a balloon at the end of the tube. It shall be inflated until only 60 ml., and then deflated at the same rythm, which is constant during each test. The first test takes place at the speed of 30 ml. per minute; so the inflation lasts 2 mn and the deflation the same time, afterwards the second test lasts one mn for each one, and finally the third one 40 seconds in the same way. For the anal canal, the balloon, ring shaped around the tube, measuring an inch in length, is inflated at only 12 ml. For the first test the inflation and deflation rate of speed is 3 ml per mn, afterwards 6 ml./mn then 9 ml./mn. and thereafter 12 ml./mn/; these series are done in randomized order. In both procedures, an additional relaxation test at the maximum of inflation takes place for 2 minutes. We have explored ten healthy volunteers and 120 patients suffering from various digestive diseases. The curves show the rectal compliance, and in the case of the anus a relaxation, which seems to be an active opening, occurs for a distension of 5-8 ml, i.e. 19-21 mn in diameter. In pathology, the excess of compliance is observed in patients with incontinence, whereas an inadequate compliance is seen in the dyschesia, descending perineum and prolapse, traumatic or surgical injuries, etc. This exploration will be a useful guide for the choice of the convenient treatment and the follow-up.
我们研发了一种测定直肠和肛管顺应性的原创方法。直肠必须充当粪便储存库。这种储存功能要求直肠必须具有可扩张性。肛管必须易于松弛以便排便。通常的直肠肛管测压记录并未探究这些特性。关于顺应性的研究极少。在我们的操作中，探测球囊通过聚乙烯管连接到压力传感器、直接记录式电子记录仪和在计算机指令下的泵。产生的压力越高，扩张性越差，顺应性越低。压力/容积曲线显示顺应性。直肠和肛管的操作程序不同。直肠装置由管末端的一个球囊组成。将其充气至仅60毫升，然后以相同的节奏放气，每次测试时节奏保持恒定。第一次测试以每分钟30毫升的速度进行；所以充气持续2分钟，放气也持续相同时间，之后第二次测试每次持续1分钟，最后第三次以同样的方式持续40秒。对于肛管，围绕管子呈环形的球囊，长度为1英寸，仅充气至12毫升。第一次测试时充气和放气速度为每分钟3毫升，之后是每分钟6毫升、9毫升，再之后是每分钟12毫升；这些系列以随机顺序进行。在这两种操作中，在最大充气量时进行额外的2分钟松弛测试。我们对10名健康志愿者和120名患有各种消化系统疾病的患者进行了检查。曲线显示了直肠顺应性，对于肛门而言，在扩张5 - 8毫升（即直径19 - 21毫米）时会出现一种似乎是主动开放的松弛。在病理学上，失禁患者观察到顺应性过高，而在排便困难、会阴下降和脱垂、创伤或手术损伤等情况下则可见顺应性不足。这种检查将为选择合适的治疗方法和随访提供有用的指导。
