Anorectal Disorders
Anorectal Disorders
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DOI：
10.1053/j.gastro.2016.02.009
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发表时间：
2016-05-01
期刊：
影响因子：
29.4
通讯作者：
Wald, Arnold
中科院分区：
文献类型：
--
作者：
Rao, Satish S. C.;Bharucha, Adil E.;Wald, Arnold
本报告定义了以下常见肛门直肠疾病的标准并回顾了流行病学、病理生理学和治疗：大便失禁 (FI)、功能性肛门直肠疼痛和功能性排便障碍。 FI 定义为粪便反复不受控制地排出至少 3 个月。 FI 的临床特征对于指导诊断测试和治疗非常有用。肛门直肠测压和成像可用于评估肛门和盆底结构和功能。教育、止泻和生物反馈治疗是治疗的支柱；手术对于难治性病例可能有用。功能性肛门直肠疼痛综合征根据临床特征定义，分为 3 种亚型。在一过性直肠痛中，疼痛通常是短暂的，持续几秒到几分钟。在提肛综合征和未特指的肛门直肠疼痛中，疼痛持续超过30分钟，但在提肛综合征中存在耻骨直肠肌压痛。功能性排便障碍的定义为≥2种慢性便秘或伴有便秘的肠易激综合征症状，并且具有≥2种排便障碍特征，即测压法排便模式异常、球囊排出试验异常或影像学显示直肠排便障碍。它包括 2 种亚型：排便协同失调和排便推进力不足。盆底生物反馈疗法可有效治疗提肛综合征和排便障碍。
This report defines criteria and reviews the epidemiology, pathophysiology, and management of the following common anorectal disorders: fecal incontinence (FI), functional anorectal pain, and functional defecation disorders. FI is defined as the recurrent uncontrolled passage of fecal material for at least 3 months. The clinical features of FI are useful for guiding diagnostic testing and therapy. Anorectal manometry and imaging are useful for evaluating anal and pelvic floor structure and function. Education, antidiarrheals, and biofeedback therapy are the mainstay of management; surgery may be useful in refractory cases. Functional anorectal pain syndromes are defined by clinical features and categorized into 3 subtypes. In proctalgia fugax, the pain is typically fleeting and lasts for seconds to minutes. In levator ani syndrome and unspecified anorectal pain, the pain lasts more than 30 minutes, but in levator ani syndrome there is puborectalis tenderness. Functional defecation disorders are defined by >= 2 symptoms of chronic constipation or irritable bowel syndrome with constipation, and with >= 2 features of impaired evacuation, that is, abnormal evacuation pattern on manometry, abnormal balloon expulsion test, or impaired rectal evacuation by imaging. It includes 2 subtypes: dyssynergic defecation and inadequate defecatory propulsion. Pelvic floor biofeedback therapy is effective for treating levator ani syndrome and defecatory disorders.