Sun W M, Katsinelos P, Horowitz M, Read N W
Department of Medicine, Royal Adelaide Hospital, Australia.
Eur J Gastroenterol Hepatol. 1996 Oct;8(10):1007-12. doi: 10.1097/00042737-199610000-00014.
The pathophysiology of faecal incontinence in diabetes mellitus is poorly understood. The study was designed to document the anorectal dysfunctions in diabetic patients with faecal incontinence.
Multiport anorectal manometry and electromyography were done in 11 diabetic patients with faecal incontinence and in 20 healthy controls.
Basal and squeeze pressures were reduced (P < 0.05) in the diabetic patients compared with the control subjects. During basal recording six patients showed regular oscillations in anal electrical activity and pressure with an amplitude of 10-40 (median: 25) cmH2O and a frequency of 6-10 (median: 8) min-1. Nine patients also exhibited spontaneous transient anal relaxations with an amplitude of 15-50 (median: 40) cmH2O and a duration of 15-720 (median: 60)s, and in six of them leakage occurred as the anal pressure fell below the rectal pressure. None of the control subjects showed oscillation or spontaneous relaxations. In patients there was a greater tendency for repetitive rectal contractions in response to rectal distension and reduced rectal compliance (P < 0.01). During rectal distension four patients showed no anal relaxation, and in the remainder relaxation occurred at an abnormally high threshold. However, the residual pressures were lower (P < 0.05) than in control subjects and often fell below rectal pressure, whereupon leakage occurred. There was no significant difference in the distension thresholds for rectal sensation between patients and control subjects, but in 9/11 patients the perception of rectal sensation was delayed by more than 2s (P < 0.05).
These results indicate that aetiology of faecal incontinence in diabetic patients is multifactorial and, suggest for the first time, that instability of the internal sphincter probably plays a major role.
糖尿病患者大便失禁的病理生理学机制尚不清楚。本研究旨在记录糖尿病大便失禁患者的肛门直肠功能障碍情况。
对11例糖尿病大便失禁患者和20例健康对照者进行多通道肛门直肠测压和肌电图检查。
与对照组相比，糖尿病患者的基础压力和收缩压力降低（P<0.05）。在基础记录期间，6例患者肛门电活动和压力出现规则振荡，振幅为10-40（中位数：25）cmH2O，频率为6-10（中位数：8）次/分钟。9例患者还出现自发性短暂肛门松弛，振幅为15-50（中位数：40）cmH2O，持续时间为15-720（中位数：60）秒，其中6例在肛门压力低于直肠压力时发生渗漏。对照组均未出现振荡或自发性松弛。患者对直肠扩张的重复性直肠收缩倾向更大，直肠顺应性降低（P<0.01）。在直肠扩张期间，4例患者未出现肛门松弛，其余患者在异常高的阈值下出现松弛。然而，残余压力低于对照组（P<0.05），且常低于直肠压力，随即发生渗漏。患者与对照组之间直肠感觉的扩张阈值无显著差异，但11例患者中有9例直肠感觉的感知延迟超过2秒（P<0.05）。
这些结果表明，糖尿病患者大便失禁的病因是多因素的，首次提示内括约肌不稳定可能起主要作用。
