【摘要】 目的探讨不同性别、年龄、症状的功能型便秘患者肛门直肠测压的特点,指导该技术在临床的应用,辅助临床诊断与治疗。方法回顾性分析广东省人民医院老年医学研究所胃肠动力室85例功能性便秘排便障碍型患者,分别用三维高分辨直肠测压技术进行测量,并分析不同性别、年龄、不同症状功能性便秘患者肛门直肠压力变化的特点。结果三维高分辨肛门直肠测压显示,老年患者和非老年患者肛管静息压、肛管最大收缩压、肛门松驰率、肛门直肠压力差差异有统计学意义(P<0.05);非老年男性与非老年女性肛管最大收缩压、直肠压力、肛门松驰率差异有统计学意义(P<0.05);老年男性与老年女性肛管静息压、肛管最大收缩压、肛门直肠压力差差异有统计学意义(P<0.05);根据粪便性性状不同,分为Bristol1-3型和Bristol4-7型,可见测量指标中两者肛门松驰率差异有统计学意义(P<0.05)。其他测量指标未见明显差异(P> 0.05)。结论老年及非老年功能性便秘患者中均存在直肠推进力不足和盆底肌不协调收缩,老年患者主要表现为直肠推进力不足,而非老年患者则表现为不协调收缩。非老年男性患者表现为肛管矛盾收缩、松驰率低;非老年女性患者表现为盆底肌功能紊乱和直肠压力低。老年男性肛门直肠压力差下降更明显,老年男性直肠压力梯度下降可能是导致便秘的主要原因。三维高分辨肛门直肠测压在功能性便秘排便障碍的诊治过程中具有良好的应用价值,可以临床推广运用。更多还原

【Abstract】 Objective To investigate the characteristics of anorectal manometrics of functional constipation(FC)patients with different genders,ages,and symptoms,and furthermore guide the application of this technique to better assist clinical diagnosis and treatment. Methods A retrospective analysis was carried out on 85 patients,enrolled from Gastrointestinal Movement Department of Geriatics Institute of Guangdong Provincial People′s Hospital,with FC and defecation disorders. Among them,32 were younger than 60 years old(non-elderly group),53 were 60 years old and above(elderly group). Three-dimensional high-resolution anorectal manometry(3 DHARM)was used to measure anorectal pressure,and unravel characteristics of pressure changes in patients with FC of different gender,age,and different symptoms. Results 3 DH-ARM showed that the resting pressure and maximum systolic pressure of the anal canal,anal laxation rate and anorectal pressure difference were significantly different between the elderly and non-elderly groups(P<0.05). Maximum systolic pressure of the anal canal,rectal pressure and anal laxation rate were observed significantly different with gender in non-elderly group(P<0.05).While in theelderly group,significant gender difference was found in resting pressure and maximum systolic pressure of the anal canal,anorectal pressure difference(P<0.05). Patients were further divided into Bristol 1 ～ 3 and Bristol 4 ～ 7 groups based on different stool characteristics. The rate of anal laxation of Bristol4-7 group was higher than that in Bristol1-3 group(P < 0.05),no significant difference was observed in other anorectal manometrics(P > 0.05). Conclusions FC in either age was caused by insufficient rectal propulsion and uncoordinated contraction of pelvic floor muscles. Furthermore,FC in older age was associated with a weaker rectal propulsion.whereas uncoordinated contraction of rectus lead to FC in non-elderly patients. Contractility of the anal canal low anal laxation rate was present among non-elderly male with FC,while those non-elderly female patients feature elvic floor muscles dysfunction and low rectal pressure. A reduced anorectal pressure difference was evident in the elderly male patients,indicating the decreased pressure gradient could be a major cause of FC in the elderly male.3 DH-ARM features good application value in the diagnosis and treatment of FC caused by defecation disorders,and was worth being applied in clinical practice.更多还原