MECHANISMS OF ENTERIC CONTINENCE IN HEALTH AND DISEASE

肛门直肠和远端结肠功能障碍 对几个重要但定义不清的临床 问题，包括大便失禁，便秘，直肠 脱垂、肛裂和其他肛周问题。 重新 对直肠结肠切除术后保留括约肌手术的兴趣 对这一地区的功能给予了更多的重视。 然而，要更好地了解这些情况， 在更好地定义该地区的正常生理， 反过来，受到当前方法的限制。 我们的长期目标 是为了开发更好的技术， 生理学，并利用这些技术来检查 在健康、疾病和 术后 具体目标是：（1）准确定义 肛管高压区 这项技术需要 嵌入径向定向的换能器阵列， 在柔性探针中，并通过 计算机动态重建 2)准确定义 肛门直肠角 这项技术使用了放射性标记的液体- 填充的气囊，通过肛管放置。 它的形象 通过同步计算机化静态和 动态定量，肛门直肠角度和长度， 肛管的下降和开放压力。 3)测量 直肠调节。 这项技术需要记录 通过测量直肠壁的体积变化， 直肠内气囊通过一个 电子恒压器 4)以确定直肠的推进力。 该技术采用直肠内探针，其构造使得 只有轴向指向探针尖端的力 记录。5)描述更好的直肠排空。 的 这项技术包括向病人体内注入人造放射性标记的粪便， 通过静态测量改变直肠排空率和定量直肠排空率 和动态心电图成像。 6)应用这些技术 依次a）健康以建立正常生理值，B） 在确定的常见肛门直肠疾病患者人群中， 疾病如失禁、便秘、脱垂和裂缝， c）在具有肛门直肠表现的患者的限定人群中 炎症性肠病，和d）在定义的人群中， 保留括约肌手术后的患者。

Disturbances of function of the anorectum and distal colon contribute notably to several important but ill-defined clinical problems, including fecal incontinence, constipation, rectal prolapse, fissure-in-ano, and other perianal problems. A renewed interest in sphincter sparing operations after proctocolectomy has given additional emphasis to the functions of this region. However, a better understanding of these conditions is dependent upon better definition of the region's normal physiology which, in turn, is restricted by current methodologies. Our long-term goals are to develop better techniques, by which to define anorectal physiology, and to utilize these techniques to examine mechanisms of continence and defecation in health, in disease and after operation. The specific aims are: 1) To define precisely the high pressure zone of the anal canal. The technique entails imbedding an array of transducers which are orientated radially, in a flexible probe, and reproducing pressure profiles by computerized dynamic reconstruction. 2) To define accurately the anorectal angle. The technique employs a radiolabelled, fluid- filled balloon, placed through the anal canal. It images scintigraphically, by simultaneous computerized static and dynamic quantification, the anorectal angle and the length, descent and opening pressure of the anal canal. 3) To measure rectal accommodation. The technique entails recording tone of the rectal wall indirectly by measuring changes in volume of an intrarectal balloon maintained at constant pressure by an electronic barostat. 4) To define propulsive forces in the rectum. The technique employs an intrarectal probe constructed such that only forces directed axially, against the tip of the probe, are recorded. 5) To characterize better rectal evacuation. The technique involves instilling artificial radiolabelled stool of varying consistencies and quantifying rectal emptying by static and dynamic scintigraphic imaging. 6) To apply these techniques sequentially a) in health to establish normal physiologic values, b) in defined populations of patients with common anorectal disorders such as incontinence, constipation, prolapse and fissure, c) in defined populations of patients with anorectal manifestations of inflammatory bowel disease, and d) in defined populations of patients after sphincter-sparing operations.