Buch E, Alós R, Solana A, Roig J V, Fernández C, Díaz F
Service of General and Digestive Surgery, Sagunto Hospital, Valencia, Spain.
Rev Esp Enferm Dig. 1998 Feb;90(2):85-93.
Anorectal manometry provides objective information on the sphincter function of the anal canal. However, in many centers sphincter function is evaluated by digital examination, due to the unavailability of manometry.
A study is made to correlate the sensitivity and specificity of a quantitative digital examination in the analysis of sphincter tone with the pressures recorded by manometry, and to examine the capacity of both techniques to discriminate continent subjects and incontinent patients.
A total of 191 patients were divided into three groups: control (C), obstructive defecation (OD) and fecal incontinence (FI). Subjective quantitative digital evaluation of anal tone was performed on a scale of 0 to 5 points at rest, and 0 to 10 points at squeeze. A correlation analysis was performed, and the sensitivity and specificity of each fecal incontinence diagnostic test was determined.
Digital examination found rectal tone to be diminished in elderly patients. A significant correlation was established between the digital and manometric tone readings, both at rest and at squeeze. Both techniques showed a low anal sphincter pressure in the FI group versus the C and OD groups. Differences in tone were recorded between the C and OD groups with manometry, but not with digital examination. The latter was in turn found to be more sensitive but less specific than manometry in differentiating between fecal continence and incontinence.
Although digital examination does not substitute anorectal manometry, a good correlation exists between the two techniques. In this sense, digital examination may afford an approximate clinical evaluation of some fecal continence mechanisms in those centers where manometry is not available.
肛门直肠测压可提供肛管括约肌功能的客观信息。然而，在许多中心，由于无法进行测压，括约肌功能是通过指诊来评估的。
本研究旨在将定量指诊在分析括约肌张力时的敏感性和特异性与测压记录的压力进行相关性分析，并检验这两种技术区分大便失禁患者和大便节制者的能力。
总共191例患者被分为三组：对照组（C）、排便梗阻组（OD）和大便失禁组（FI）。在静息状态下对肛门张力进行主观定量指诊评估，范围为0至5分，在收缩状态下为0至10分。进行相关性分析，并确定每项大便失禁诊断试验的敏感性和特异性。
指诊发现老年患者直肠张力降低。在静息和收缩状态下，指诊和测压的张力读数之间均建立了显著相关性。与C组和OD组相比，FI组的两种技术均显示肛门括约肌压力较低。测压显示C组和OD组之间存在张力差异，但指诊未发现。在区分大便节制和失禁方面，发现指诊比测压更敏感但特异性更低。
虽然指诊不能替代肛门直肠测压，但这两种技术之间存在良好的相关性。从这个意义上说，在没有测压设备的中心，指诊可以对一些大便节制机制进行大致的临床评估。
