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明确的临床 问题，包括大便失禁、便秘、直肠 脱垂、肛裂和其他肛周问题。一个新的 对直肠切除后保留括约肌手术的兴趣 特别强调了这一区域的职能。 然而，对这些情况的更好理解取决于 根据对该地区正常生理的更好定义，在 转折，受到当前方法学的限制。我们的长期目标 是开发更好的技术，用来定义肛门直肠 生理学，并利用这些技术检查 健康、疾病和精神疾病中排便障碍的机制 手术后。具体目标是：1)准确地定义 肛管高压区。这项技术需要 嵌入径向定向的换能器阵列， 在柔性探头中，并通过以下方式再现压力分布 计算机化的动态重建。2)准确定义 肛门直肠角度。这项技术使用了放射性标记的液体- 充气的气球，通过肛管放置。IT图像 闪烁，通过同时计算机化的静态和 动态定量，肛门直肠角度和长度， 肛管下降和开放压力。3)测量 直肠调节。这项技术需要录制音调 通过测量直肠壁的体积变化来间接测量直肠壁 直肠内气囊维持恒压 电子稳压计。4)确定直肠内的推进力。 该技术使用直肠内探头，其构造如下 只有朝向探头尖端的轴向力才是 录制好了。5)确定更好的直肠排空功能。这个 技术包括滴注人工放射性标记粪便 不同的一致性和静态直肠排空的量化 和动态核素成像。6)应用这些技术 依次a)在健康中建立正常的生理值，b) 在确定的常见肛门直肠疾病患者群体中 如大小便失禁、便秘、脱垂和裂缝等疾病， C)在有肛门直肠症状的特定人群中 炎症性肠病，以及d)在确定的人群中 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.