直肠黏膜脱垂与直肠全层内脱垂的肛管直肠动力学差异  

Differences in anorectal dynamics between patients with rectal mucosal prolapse and those with full-thickness intussusception

作　　者：余苏萍[1,2] 丁义江[1,2] 叶辉[1,2] 潘世友[1,2] 丁曙晴[1,2] 王小峰[1,2] 

机构地区：[1]南京中医药大学第三附属医院肛肠科 [2]全国中医肛肠医疗中心,江苏省南京市210001

出　　处：《世界华人消化杂志》2010年第34期3709-3713,共5页World Chinese Journal of Digestology

摘　　要：目的:探讨直肠黏膜内脱垂与直肠全层内脱垂的肛管直肠动力学差异.方法:对以出口梗阻性便秘为主症,排粪造影诊断为直肠内脱垂的97例患者,行肛管直肠压力测定及直肠顺应性检查.根据盆腔造影结合排粪造影将直肠内脱垂分为直肠黏膜内脱垂68例(Ⅰ组)和直肠全层内脱垂29例(Ⅱ组).设正常对照组22例.回顾性研究肛管直肠压力测定及直肠顺应性.结果:直肠全层内脱垂组与直肠黏膜内脱垂组相比,直肠顺应性明显增加(阈感觉:12.2mL/mmHg±7.2mL/mmHg vs6.4mL/mmHg±3.8mL/mmHg,P<0.05;排便感:16.6mL/mmHg±15.9mL/mmHg vs4.7mL/mmHg±2.1mL/mmHg,P<0.05;最大耐受:14.9mL/mmHg±6.9mL/mmHg vs6.3mL/mmHg±1.9mL/mmHg,P<0.05).肛管最大收缩压明显降低(82.3mmHg±28.1mmHg vs136.8mmHg±30.7mmHg,P<0.01).直肠肛管抑制反射阴性率明显增加(58.6%vs0.0%,P<0.01).内括约肌松弛百分率明显降低(52.5%±25.1%vs66.0%±17.7%,P<0.01).结论:直肠黏膜内脱垂与直肠全层内脱垂患者肛管直肠动力学存在差异.AIM：To investigate the differences in anorectal dynamics between patients with rectal mucosal prolapse and those with full-thickness intussus-ception.METHODS：Ninety-seven patients with chief complain of outlet obstructive constipation were enrolled in this study.Each patient underwent anorectal manometry and assessment of rectal compliance.Based on findings on defecography and pelvicography,the patients were allocated into two groups：rectal mucosal prolapse group（n=68）and full-thickness intussusception group（n=29）.A control group consisting of 22 normal individuals was also studied.RESULTS：Compared with the rectal mucosal prolapse group,patients of the full-thickness intussusception group had increased rectal compliance（rectal threshold sensation：12.2 mL/mmHg±7.2 mL/mmHg vs 6.4 mL/mmHg ±3.8 mL/mmHg,P0.05;sense of defecation：16.6 mL/mmHg±15.9 mL/mmHg vs 4.7 mL/mmHg±2.1 mL/mmHg,P0.05;rectal maximal tolerance：14.9 mL/mmHg±6.9 mL/mmHg vs 6.3 mL/mmHg±1.9 mL/mmHg,P0.05）,decreased anal maximal squeeze pressure（82.3 mmHg±28.1 mmHg vs 136.8 mmHg±30.7 mmHg,P0.01）,elevated rate of negative anorectal inhibitory reflex（58.6%vs 0.0%,P0.01）,and reduced percentage of internal anal sphincter relaxation（52.5%±25.1% vs 66.0%±17.7%,P0.01）.CONCLUSION：There are significant differences in anorectal dynamics between patients with rectal mucosal prolapse and those with full-thickness intussusception.

关 键 词：肛管直肠压力测定 直肠顺应性 直肠内脱垂 直肠黏膜内脱垂 直肠全层内脱垂 肛管直肠动力学 

分 类 号：R657.1[医药卫生—外科学]