Fecal incontinence with normal anal canal pressures: Where is the pitfall?
Fecal incontinence with normal anal canal pressures: Where is the pitfall?
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DOI：
10.1111/j.1572-0241.1999.01144.x
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发表时间：
1999-06-01
影响因子：
9.8
通讯作者：
Gosselin, M
中科院分区：
文献类型：
--
作者：
Siproudhis, L;Bellissant, E;Gosselin, M
目的：在进行肛门测压时，三分之一患有大便失禁的受试者被发现其值在正常范围内。对于这些患者，一种假设是直肠对扩张的适应性受损。本研究的目的是分析这一人群对直肠等压扩张的肛门直肠反应。方法：这是一项前瞻性研究，51名连续的失禁患者(45名女性，6名男性)根据其肛门功能状态分为两组：无肛门功能组(19例，年龄55岁+/-6岁)或有测压肛门功能不全组(32例，年龄59+/-2岁)。受试者接受了两种随机模式的直肠等压扩张(强直性、相位性)，并使用电子稳压装置。结果：与有肛门无力的患者相比，无肛门无力的患者在上部(36.9+/-2.2vs22.9+/-1.4 mm Hg；p=0.01)和下部(41.0+/-2.0vs23.3+/-1.4 mm Hg；；直肠等压扩张后，直肠容量(68.5+/-5.5mlvs 121.8+/-7.0ml；p=0.008)明显降低。结论：无肛门测压功能障碍的患者，其排便功能下降可能与其排便功能下降有关。胃肠病杂志1999；94：1556-1563。(C)1999年由上午科尔。胃肠病学)。
OBJECTIVE: One third of subjects who suffer from fecal incontinence are found to have values within the normal range when anal manometry is performed. For these patients, one hypothesis is that impaired rectal adaptation to distension may occur. The aim of our study was to analyze anorectal responses to rectal isobaric distension in this population.METHODS: This was a prospective study conducted in 51 consecutive incontinent patients (45 female, six male) divided into two groups according to their functional anal state: absence (19 patients aged 55 +/- 6 yr) or presence of manometric anal weakness (32 patients aged 59 +/- 2 yr). The subjects were submitted to two randomized modes of rectal isobaric distension (tonic, phasic) with an electronic barostat. Anal pressures, perception, and volumes of the rectum were recorded at six different preselected pressures.RESULTS: As compared with those having anal weakness, patients with no anal weakness retained higher mean pressures at both upper (36.9 +/- 2.2 vs 22.9 +/- 1.4 mm Hg; p = 0.01) and lower parts (41.0 +/- 2.0 vs 23.3 +/- 1.4 mm Hg; p = 0.002) of the anal canal, similar perception scores, but much lower rectal volumes (68.5 +/- 5.5 vs 121.8 +/- 7.0 ml; p = 0.008) in response to rectal isobaric distension.CONCLUSION: A decrease in octal adaptation could be involved in fecal leakage in patients with no anal manometric weakness. (Am J Gastroenterol 1999;94:1556-1563. (C) 1999 by Am. Coll. of Gastroenterology).