Rao S S, Patel R S
Division of Gastroenterology, University of Iowa, College of Medicine, Iowa City, USA.
Am J Gastroenterol. 1997 Mar;92(3):469-75.
The clinical usefulness of assessing anorectal physiology has not been systematically examined. Our aims were to evaluate whether manometric tests of anorectal function influence the management and outcome of patients with defecation disorders, and to identify the patients who may most benefit from this assessment.
Using a standard protocol of anorectal manometry rectal sensation, saline continence, simulated defecation, and pudendal nerve terminal latency tests, we studied 143 consecutive patients (m/f = 27/116) and followed their progress over 18 months.
Tests of anorectal function in 126 (88%) patients revealed new information that led to a change in the management of 108 (76%) patients. Among 69 patients referred with constipation, 33 (48%) had obstructive defecation, and 40 (58%) had impaired rectal sensation; 30 (43%) improved after biofeedback therapy. Among 56 patients referred with fecal incontinence, 55 (98%) had manometric abnormalities: 30 (53%) had a low squeeze sphincter pressure, 20 (36%) had impaired rectal sensation, and 28 (50%) had pudendal neuropathy. Thiry-four (60%) patients were referred for biofeedback therapy and 11 (20%) for surgery. Of these 15 completed biofeedback therapy with improvement, and six had successful surgery. Seven of 10 (70%) patients referred for preoperative evaluation had abnormalities that contraindicated surgery.
Manometric tests of anorectal function provide not only an objective diagnosis but, also, a better understanding of the underlying pathophysiology. In addition, it provides new information that could influence the management and outcome of patients with disorders of defecation.
评估肛门直肠生理学的临床实用性尚未得到系统研究。我们的目的是评估肛门直肠功能的测压测试是否会影响排便障碍患者的管理和预后，并确定可能从该评估中获益最大的患者。
我们使用肛门直肠测压的标准方案，包括直肠感觉、盐水控便、模拟排便和阴部神经终末潜伏期测试，对143例连续患者（男/女 = 27/116）进行了研究，并随访了他们18个月的病情进展。
126例（88%）患者的肛门直肠功能测试揭示了新信息，导致108例（76%）患者的管理发生改变。在69例因便秘就诊的患者中，33例（48%）存在排便梗阻，40例（58%）直肠感觉受损；30例（43%）在生物反馈治疗后有所改善。在56例因大便失禁就诊的患者中，55例（98%）存在测压异常：30例（53%）括约肌收缩压较低，20例（36%）直肠感觉受损，28例（50%）存在阴部神经病变。34例（60%）患者被转诊接受生物反馈治疗，11例（20%）接受手术治疗。这15例患者完成生物反馈治疗后病情改善，6例手术成功。10例接受术前评估转诊的患者中有7例（70%）存在手术禁忌的异常情况。
肛门直肠功能的测压测试不仅能提供客观诊断，还能更好地理解潜在的病理生理学。此外，它还能提供新信息，可能影响排便障碍患者的管理和预后。
