【作者】 徐岚；

【导师】 许春芳；

【作者基本信息】 苏州大学 ， 内科学（消化系病学）（专业学位）， 2022， 硕士

【摘要】 背景与目的既往关于功能性便秘(FC)的研究中,大多简单描述便秘的症状及其频率模式,对于症状与病理生理学机制之间的联系观点不一,且较少将症状与肛门直肠测压(ARM)特征关联起来。本研究分析FC症状与基于高分辨率肛门直肠测压(HR-ARM)诊断的肛门直肠动力、感觉异常的相关性,以探讨FC症状的潜在病理生理学异常。方法前瞻性收集2020年6月至2021年12月在苏州大学附属第一医院行HR-ARM的FC患者资料,在检查前记录便秘症状的发生情况并填写症状评分系统(CSS),分析症状与测压参数、结果的相关性。功能性排便障碍(FDD)患者行生物反馈治疗,治疗前后填写CSS及便秘患者生活质量量表(PAC-QOL)。结果1.本研究纳入79例FC患者,有排便费力症状的患者62例(78.5%)。根据HR-ARM和球囊逼出试验(BET)结果,诊断出FDD患者60例(75.9%),包括不协调性排便32例(40.5%),排便推进力不足28例(35.4%);其余19例(24.1%)患者不存在排便动力障碍。在直肠敏感性方面,诊断出直肠低敏感(RH)患者 15 例(19.0%)。2.在HR-ARM参数方面,有排便费力症状的患者较无排便费力症状的患者肛管残余压高(t=2.359,P=0.021)、肛管松弛率低(t=-2.996,P=0.004)、直肠推进压高(t=3.099,P=0.003)。粪便干硬的患者直肠推进压低于粪便柔软的患者(t=-2.440,P=0.017)。需要辅助排便的患者较无需辅助排便的患者肛管残余压高(t=2.249,P=0.027)、急迫便意阈值低(U=451.000,P=0.013)。有腹胀感觉的患者初始感觉阈值低于无腹胀的患者(U=532.500,P=0.016)。3.进一步比较HR-ARM结果,相较于无排便费力症状的患者而言,有排便费力症状的患者不协调性排便的发生率高(χ2=4.697,P=0.030)。4.CSS总分与肛管残余压存在正相关关系(r=0.263,P=0.019),与肛管松弛率存在负相关关系(r=-0.386,P<0.001)。5.FDD患者进行生物反馈治疗后,CSS总分(Z=-3.178,P=0.001)和PAC-QOL 总分(Z=-2.919,P=0.004)明显降低。结论1.FC患者的排便费力症状主要与不协调性排便有关,而非排便推进力不足。2.肛管残余压高、肛管松弛率低的FC患者表现出更严重的便秘症状,这两个参数可以更好地评估FC病理生理学异常。更多还原

【Abstract】 Background and Objective In previous studies on functional constipation(FC),symptoms were briefly described.Views differed on the relation between symptoms and pathophysiological mechanisms.Constipation symptoms were rarely associated with characteristics of anorectal manometry(ARM).In this study,we analyzed the correlation of symptoms,anorectal motor dysfunction and paresthesia diagnosed by high-resolution anorectal manometry(HR-ARM)to investigate the underlying pathophysiological abnormalities of symptoms.Methods Patients with FC who underwent HR-ARM were prospectively collected in the First Affiliated Hospital of Soochow University from June 2020 to December 2021.We recorded the occurrence of constipation symptoms and constipation scoring system(CSS)to analyze the correlation of symptoms,manometry parameters and results.Patients with functional defecation disorder(FDD)were treated with biofeedback therapy.They filled out the CSS and patient assessment of constipation quality of life questionnaire(PAC-QOL)before and after the therapy.Results 1.A total of 79 patients with FC were recruited in this study,among which 62(78.5%)were patients with straining.According to the results of HR-ARM and balloon expulsion test(BET),we diagnosed 60 patients(75.9%)with FDD,including 32 patients(40.5%)with dyssynergic defecation and 28 patients(35.4%)with inadequate defecatory propulsion.The remaining 19 patients(24.1%)did not have anorectal motor dysfunction.There were 15 patients(19.0%)with rectal hyposensitivity(RH).2.In terms of manometry parameters,patients with straining had higher anal residual pressure(t=2.359,P=0.021),lower anal relaxation rate(t=-2.996,P=0.004)and higher rectal propulsive pressure(t=3.099,P=0.003).Patients with hard stools had lower rectal propulsive pressure(t=2.440,P=-0.017).Patients who needed manual maneuvers to facilitate defecation had higher anal residual pressure(t=2.249,P=0.027)and lower defecation urge volume(U=451.000,P=0.013).The first sensitive volume of patients with abdominal bloating was lower than that of patients without abdominal bloating(U=532.500,P=0.016).3.Further comparison of manometry results showed that patients with straining had higher incidence of dyssynergic defecation(χ2=4.697,P=0.030).4.CSS score was positively correlated with anal residual pressure(r=0.263,P=0.019)and negatively correlated with anal relaxation rate(r=-0.386,P<0.001).5.The total scores of CSS(Z=-3.178,P=0.001)and PAC-QOL(Z=-2.919,P=0.004)of patients with FDD were significantly decreased after biofeedback therapy.Conclusion 1.The symptom of straining in patients with FC was primarily associated with dyssynergic defecation rather than inadequate defecatory propulsion.2.High residual anal pressure and low anal relaxation rate in patients with FC had more severe symptoms.They could better assess the pathophysiological abnormalities of FC.更多还原