Pfeifer J, Teoh T A, Salanga V D, Agachan F, Wexner S D
Department of Colorectal Surgery, Cleveland Clinic Florida, Fort Lauderdale 33309, USA.
Dis Colon Rectum. 1998 Sep;41(9):1153-7. doi: 10.1007/BF02239438.
The aim of this study was to compare the intra-anal sponge electrode with the conventional needle electrode for electromyography of the pelvic floor in constipated patients.
Forty consecutive patients (27 females) with a mean age of 64.3 (range, 15-87) years who had chronic constipation were prospectively evaluated for electromyographic evidence of nonrelaxation or paradoxical contraction of the puborectalis and external anal sphincter during simulated defecation. The soft intra-anal sponge electrode and then the concentric needle electrode were used in each patient as an internal control. Furthermore, in all patients, cinedefecography was used as an independent standard to confirm the diagnosis. Agreement was calculated using the kappa statistic.
Confirmation of needle electromyography was noted in 19 of 20 patients (95 percent) who had sponge electromyographic evidence of paradoxical activity. Similarly, concurrence was noted in 19 of 20 patients (95 percent) with normal relaxation of the puborectalis observed with the sponge electrode. Agreement between needle and sponge electromyography was very good (kappa = 0.9), between needle electromyography and cinedefecography was fair (kappa = 0.4), and between sponge electromyography and cinedefecography was moderate (kappa = 0.5). Furthermore, needle electromyography was more painful in all patients compared with sponge electromyography.
The soft sponge surface intra-anal electrode is an excellent alternative to the needle electrode for assessment of puborectalis activity in constipated patients. Sponge electromyography has the advantage of being as accurate as, but less painful than, needle electromyography.
本研究旨在比较肛门内海绵电极与传统针电极在便秘患者盆底肌电图检查中的应用。
对40例连续的慢性便秘患者（27例女性）进行前瞻性评估，这些患者平均年龄64.3岁（范围15 - 87岁），评估其在模拟排便过程中耻骨直肠肌和肛门外括约肌非松弛或矛盾收缩的肌电图证据。在每位患者中，先使用柔软的肛门内海绵电极，然后使用同心针电极作为内部对照。此外，对所有患者均采用排粪造影作为独立标准来确诊。使用kappa统计量计算一致性。
在20例海绵肌电图显示有矛盾活动证据的患者中，有19例（95%）针电极肌电图得到证实。同样，在20例海绵电极显示耻骨直肠肌正常松弛的患者中，有19例（95%）结果一致。针电极与海绵电极肌电图之间的一致性非常好（kappa = 0.9），针电极肌电图与排粪造影之间的一致性一般（kappa = 0.4），海绵电极肌电图与排粪造影之间的一致性中等（kappa = 0.5）。此外，与海绵电极肌电图相比，所有患者中针电极肌电图更疼痛。
对于便秘患者耻骨直肠肌活动的评估，柔软的肛门内海绵表面电极是针电极的极佳替代方法。海绵电极肌电图具有与针电极肌电图准确性相同但疼痛程度更低的优点。
