High-resolution Anorectal Manometry for Identifying Defecatory Disorders and Rectal Structural Abnormalities in Women
High-resolution Anorectal Manometry for Identifying Defecatory Disorders and Rectal Structural Abnormalities in Women
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DOI：
10.1016/j.cgh.2016.09.154
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发表时间：
2017-03-01
影响因子：
12.6
通讯作者：
Bharucha, Adil E.
中科院分区：
文献类型：
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作者：
Prichard, David O.;Lee, Taehee;Bharucha, Adil E.
背景与目的：与传统观点相反，在许多健康人中，排便过程中的直肠肛门梯度是负的，破坏了肛门直肠高分辨率测压（HRM）诊断排便障碍的实用性。我们的目的是比较HRM和磁共振成像（MRI）评估直肠排空和结构异常。（均为女性;便秘51例，大便失禁48例，直肠脱垂19例;年龄，53 +/-1岁），于2011年2月至2013年3月在明尼苏达州罗切斯特的马约诊所通过HRM、直肠球囊脱出试验（BET）和MRI进行评估。30名健康无症状女性（年龄，37 +/-2岁）作为对照。我们使用HRM变量的主成分分析来确定直肠肛门压力模式与直肠脱垂和脱垂患者的表型相关。与直肠内毒素检查结果正常的患者相比，内毒素检查异常的患者直肠内压中位数较低（36 vs 22 mm Hg，P = 0.002），直肠肛门中位梯度更负（-6 vs-29 mm Hg，P = 0.006），MRI分析的基础上更低比例的排空（中位数40% vs 80%，P <0.0001）。根据排空期间的直肠压力和肛门直肠下降以及肛管扩张得出的评分与较大的直肠前突（3厘米或更大）相关（P = 0.005）。主成分（PC）逻辑模型区分患者与非脱垂与96%的准确性。脱垂患者中，有2个表型，其特点是高（PC1）或低（PC2）肛门压力在休息和挤压沿着与较高的直肠和肛门压力（PC1）或较高的直肠肛门梯度在排空（PC2.CONCLUSIONS：在一项回顾性分析的患者评估HRM，测量直肠排空肛门直肠HRM，BET和MRI相关。单纯的HRM和在排便过程中肛门直肠下降可以分别识别直肠脱垂和大的直肠膨出，也可以识别直肠脱垂的独特表型。
BACKGROUND & AIMS: Contrary to conventional wisdom, the rectoanal gradient during evacuation is negative in many healthy people, undermining the utility of anorectal high-resolution manometry (HRM) for diagnosing defecatory disorders. We aimed to compare HRM and magnetic resonance imaging (MRI) for assessing rectal evacuation and structural abnormalities.METHODS: We performed a retrospective analysis of 118 patients (all female; 51 with constipation, 48 with fecal incontinence, and 19 with rectal prolapse; age, 53 +/- 1 years) assessed by HRM, the rectal balloon expulsion test (BET), and MRI at Mayo Clinic, Rochester, Minnesota, from February 2011 through March 2013. Thirty healthy asymptomatic women (age, 37 +/- 2 years) served as controls. We used principal components analysis of HRM variables to identify rectoanal pressure patterns associated with rectal prolapse and phenotypes of patients with prolapse.RESULTS: Compared with patients with normal findings from the rectal BET, patients with an abnormal BET had lower median rectal pressure (36 vs 22 mm Hg, P = .002), a more negative median rectoanal gradient (-6 vs -29 mm Hg, P = .006) during evacuation, and a lower proportion of evacuation on the basis of MRI analysis (median of 40% vs 80%, P < .0001). A score derived from rectal pressure and anorectal descent during evacuation and a patulous anal canal was associated (P = .005) with large rectoceles (3 cm or larger). A principal component (PC) logistic model discriminated between patients with and without prolapse with 96% accuracy. Among patients with prolapse, there were 2 phenotypes, which were characterized by high (PC1) or low (PC2) anal pressures at rest and squeeze along with higher rectal and anal pressures (PC1) or a higher rectoanal gradient during evacuation (PC2).CONCLUSIONS: In a retrospective analysis of patients assessed by HRM, measurements of rectal evacuation by anorectal HRM, BET, and MRI were correlated. HRM alone and together with anorectal descent during evacuation may identify rectal prolapse and large rectoceles, respectively, and also identify unique phenotypes of rectal prolapse.