摘要
目的 研究直肠肛门瘘手术前后肛肠动力学的变化。方法 对３７ 例肛瘘患者手术前后用直肠肛管测压法检测直肠肛门反射（ＲＡＲ） 、肛管最大收缩压（ＡＭＣＰ） 、肛管最长收缩时间（ＡＬＣＴ）、直肠静息压（ＲＲＰ）、肛管静息压（ＡＲＰ）５ 项技术指标。对肛瘘手术前后及其低位、高位手术前后、低位与高位术后进行比较，并与３０名正常人进行对比。结果 术后ＲＡＲ 完全恢复并敏感率提高（ Ｐ＜ ０－０１） ，与正常人无差异（ Ｐ＞ ０－０５） ；ＡＭＣＰ与术前无差异（ Ｐ＞ ０－０５） ，比正常人明显降低（ Ｐ＜ ０－０１） ；ＡＬＣＴ 与术前无差异（ Ｐ＞ ０－０５） ，比正常人延长（ Ｐ＜ ０－０５） ；ＲＲＰ术后降低（ Ｐ＜０－０１），与正常人无差异（ Ｐ＞ ０－０５） ；ＡＲＰ术后降低（ Ｐ＜ ０－０１），比正常人亦显著降低（ Ｐ＜ ０－０１）。结论 肛瘘疾病及肛管内外括约肌损伤的严重程度对肛门的闭紧功能产生直接影响，尤其是高位肛瘘可能引起部分患者的气体或液体失禁。
Objective To study the kinetic changes of the anorectum before and after anal fistula operation . Methods The anorectal pressure was measured with five indexes, such as rectalanalreflex (RAR) ,anal maximalcontraction pressure (AMCP) ,anallongestcontraction time (ALCT) ,rectalrest pressure (RRP) and analrest pressure (ARP) ,in 37 cases of analfistula .The comparisons,between pre and post operation , pre and post operation of low position , pre and post operation of high position ,post operation of high position and that oflow position ,37 patientsand 30 normal people, were made.Results After the operation , RAR of cases was recovered completely,its sensitive rate elevated ( P < 0-01) and had no difference with normal people. AMCPof patients was not different with pre operation ( P > 0-05) but significantly lower than that of normal people ( P< 0-01) ,and so was ALCT( P> 0-05) ,significantly longerthan that of normal people ( P< 0-01) . RRPdecreased significantly after operation ( P< 0-01) and had no difference with thatof normalpeople ( P> 0-05) .ARPdecreased significantly compared with that of pre operation and normalpeople ( P < 0-01) .Conclusions The severity of the analfistula and theinternal or external anal sphincter injury has a direct influence on anal contractive function . Especially high position fistula maylead to analincontinencein some patients.
基金
广东省卫生厅科研基金!〔1996 19 号〕
