Rectal contractility in patients with fecal incontinence and obstructed defecation compared to normal subjects.
Rectal contractility in patients with fecal incontinence and obstructed defecation compared to normal subjects.
复制标题
DOI：
10.1016/j.gastha.2023.03.002
复制
发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Mittal, Ravinder K
中科院分区：
文献类型：
--
作者：
Gregersen, Hans;Mittal, Ravinder K
在正常的排便过程中，结肠中协调的肌肉收缩将粪便移向直肠，从而刺激排便的冲动。直肠扩张引起肛门内括约肌松弛和肛门外括约肌初始收缩。 1 目前的观点是，用于启动排便的瓦氏动作会导致腹内和直肠压力增加，从而为通过放松的耻骨直肠肌和肛门括约肌排出直肠内容物提供驱动力。然而，尚不清楚直肠收缩是否在排空过程中发挥作用。Kumar 和 Wingate2 使用测压记录描述了类似于肠道迁移运动复合体的阶段性直肠活动。阻抗平面记录证明了猪的扩张引起的直肠收缩。 3 结肠和直肠的运动模式已在动物和人类身上进行了广泛研究。 1 使用光纤传感器导管对结肠进行长时间高分辨率测压 (HRM) 记录，记录逆行直肠收缩。 4 最近，描述了直肠和远端结肠的全结肠加压和逆行收缩。 1 这些与肛门括约肌松弛有关，但与腹壁收缩无关。与正常受试者（NS）相比，便秘患者在排便前阶段结直肠收缩力增加，但直肠张力增加较少。 5, 6 然而，这些研究并未描述排出阶段的直肠运动事件。记录疏散过程中涉及的生理事件存在几个问题； 1) 大多数测试需要操作员在房间内，2) HRM 仅模拟排便的排出阶段，3) 球囊排出测试 (BET) 和排粪造影不记录了解排便过程机制所需的压力。
In the normal defecation process, coordinated muscle contractions in colon move the fecal matter towards rectum, which stimulates sensation of urge-to-defecate. Rectal distension evokes relaxation of the internal anal sphincter and an initial contraction of the external anal sphincter. 1 Current thinking is that the Valsalva maneuver performed to initiate defecation results in an increase in the intra-abdominal and rectal pressure, which provides the driving force for the expulsion of rectal contents through the relaxed puborectalis and anal sphincter muscles. However, it is not clear if rectal contractions play a role in the evacuation process.Using manometric recordings, Kumar and Wingate2 described phasic rectal activity that resembled the intestinal migrating motor complex. Impedance planimetric recordings demonstrated distension-induced rectal contractions in pigs. 3 Motor patterns of the colon and rectum have been studied extensively in animals and humans. 1 Retrograde rectal contractions were recorded during prolonged high-resolution manometry (HRM) recordings of the colon using a fiber-optic transducer catheter. 4 More recently, pan-colonic pressurization and retrograde contractions of the rectum and distal colon were described. 1 These were associated with anal sphincter relaxation but not abdominal wall contractions. In constipated patients, colorectal contractility is increased in the pre-defecatory phase but with less increase in the rectal tone compared to normal subjects (NS). 5, 6 However, rectal motor events during the expulsion phase were not described in these studies. There are several problems in recording the physiological events involved in the evacuation process; 1) most tests require an operator to be present in the room, 2) HRM only simulates the expulsion phase of defecation, and 3) the balloon expulsion test (BET) and defecography do not record pressures required to understand the mechanics of evacuation process.