重度直肠前突患者肛管直肠动力学分析

许新意; 王梦杰; 薛雅红; 丁艳; 马好; 王兴宝; 樊志敏; 王小峰

doi:10.7619/jcmp.20242419

重度直肠前突患者肛管直肠动力学分析

许新意^{1, 2},
王梦杰^{1, 2},
薛雅红¹,
丁艳¹,
马好¹,
王兴宝¹,
樊志敏¹,
王小峰^1,

1.
南京中医药大学附属南京中医院肛肠科, 江苏南京, 210001
2.
南京中医药大学研究生院, 江苏南京, 210023

基金项目:

第七批全国老中医药专家学术经验继承工作项目 2022-GQPSC-XYH

江苏省中医肛肠疾病临床医学创新中心项目 GCCXZX-2021

详细信息

通讯作者:
王小峰

中图分类号: R657.1;R605;R602
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- 文章访问数: 35
- HTML全文浏览量: 9
- PDF下载量: 5
出版历程
- 收稿日期: 2024-06-06
- 修回日期: 2024-12-28
- 刊出日期: 2025-01-27

Anorectal dynamics analysis in patients with severe rectocele

1.
Anorectal Department, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, Jiangsu, 210001
2.
Graduate School, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, 210023

摘要

摘要:
目的
评估重度直肠前突患者肛管直肠动力学结果。
方法
回顾性分析2020年1月—2023年1月南京市中医院肛肠科盆底中心明确诊断为重度直肠前突的38例患者的临床资料, 对所有患者均行肛管直肠压力测定，对肛管直肠动力学结果进行分析。
结果
肛管静息压升高15例(39.47%), 正常20例(52.63%), 降低3例(7.89%); 肛管最大收缩压升高5例(13.16%), 正常9例(23.68%), 降低24例(63.16%); 排便弛缓反射正常15例(39.47%), 异常23例(60.53%); 直肠排便压正常10例(26.32%), 下降28例(73.68%); 直肠初始阈值升高11例(28.95%), 正常27例(71.05%); 直肠排便感觉阈值升高15例(39.47%), 正常21例(55.26%), 降低2例(5.26%); 直肠最大耐受量升高3例(7.89%), 正常26例(68.42%), 降低9例(23.68%)。肛管静息压与慢性便秘严重程度量表(CSS)评分呈中度正相关(P=0.007, r=0.429), 排便弛缓反射异常与CSS评分呈中度负相关(P=0.019, r=-0.329)。肛管静息压和肛管最大收缩压均降低3例(7.89%); 肛管静息压和肛管最大收缩压均升高5例(13.16%)。
结论
重度直肠前突患者术前需要进行肛管直肠动力学分析，以制订合理的个体化手术及术后康复方案。
- 直肠前突 /
- 肛管直肠压力测定 /
- 功能性排便障碍 /
- 直肠前突修补术 /
- 肛管松解术 /
- 盆底肌肉训练
Abstract:
Objective
To evaluate the results of anorectal dynamics in patients with severe rectocele.
Methods
A retrospective analysis was conducted on the clinical data of 38 patients definitively diagnosed with severe rectocele at the pelvic floor center of the anorectal department of Nanjing Hospital of Traditional Chinese Medicine from January 2020 to January 2023. All patients underwent anorectal manometry, and the results of anorectal dynamics were analyzed.
Results
A total of 15 patients (39.47%) had elevated anal resting pressure (ARP), 20(52.63%) had normal ARP, and 3(7.89%) had decreased ARP. Five patients (13.16%) had elevated maximum anal sphincter pressure (MASP), 9(23.68%) had normal MASP, and 24(63.16%) had decreased MASP. Normal defecation relaxation reflex was observed in 15 patients (39.47%), and abnormal defecation relaxation reflex was observed in 23 patients (60.53%). Ten patients (26.32%) had normal rectal defecation pressure, and 28(73.68%) had decreased rectal defecation pressure. Eleven patients (28.95%) had elevated rectal initial sensory threshold (RIST), 27(71.05%) had normal RIST. Fifteen patients (39.47%) had elevated rectal defecation sensory threshold, 21(55.26%) had normal rectal defecation sensory threshold, and 2(5.26%) had decreased rectal defecation sensory threshold. Three patients (7.89%) had elevated rectal maximum tolerable volume, 26(68.42%) had normal rectal maximum tolerable volume, and 9 (23.68%) had decreased rectal maximum tolerable volume. ARP was moderately positively correlated with the chronic constipation severity (CSS) score (P=0.007, r=0.429), and abnormal defecation relaxation reflex was moderately negatively correlated with the CSS score (P=0.019, r=-0.329). In 3 patients (7.89%), both ARP and MASP were decreased, and both ARP and MASP were elevated in 5 patients (13.16%).
Conclusion
Preoperative anorectal dynamics analysis is necessary for patients with severe rectocele to formulate a reasonable individualized surgical plan and postoperative rehabilitation program.
- rectocele /
- anorectal manometry /
- functional defecation disorder /
- rectocele repair /
- anal sphincterolysis /
- pelvic floor muscle training

HTML全文

表 1 重度直肠前突患者肛管直肠动力学分析(x±s)[n(%)]

指标	参考范围	升高		正常		降低
指标	参考范围	n	均值	n	均值	n	均值
肛管静息压	50~70 mmHg	15	80.81±7.15	20	58.20±4.51	3	33.00±6.08
肛管最大收缩压	120~170 mmHg	5	219.88±52.95	9	133.44±12.62	24	93.93±18.74
直肠排便压	>45 mmHg	—	—	10	58.30±14.02	28	29.39±8.24
直肠初始阈值	10~30 mL	11	53.64±15.67	27	22.22±5.77	—	—
直肠排便感觉阈值	50~80 mL	15	135.33±50.12	21	65.24±13.65	2	40.00
直肠最大耐受量	110~280 mL	3	316.67±28.87	26	160.00±49.15	9	81.11±15.37
1 mmHg=0.133 kPa。

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表 2 肛管直肠动力学指标与CSS的相关性分析

指标	P	r
肛管静息压	0.007	0.429
肛管最大收缩压	0.093	0.277
直肠初始阈值	0.201	0.212
直肠排便感觉阈值	0.680	0.069
直肠最大耐受量	0.481	0.118
直肠排便压	0.251	-0.191
排便弛缓反射异常	0.019	-0.329

下载: 导出CSV

表 3 肛管静息压与收缩压情况分析[n(%)]

肛管最大收缩压	肛管静息压
肛管最大收缩压	升高	降低	正常
升高	5(13.16)	0	0
降低	5(13.16)	3(7.89)	16(42.11)
正常	5(13.16)	0	4(10.53)

下载: 导出CSV

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