山东医药

目的 基于高分辨率肛门直肠测压（HR-ARM）与盆底表面肌电图（sEMG）检查，总结女性功能性排便障碍（FDD）患者的盆底功能异常特征，以指导临床治疗。方法 女性FDD患者64例记为FDD组，同期招募女性健康志愿者60例记为对照组。两组受检者均接受HR-ARM与盆底sEMG检查，记录并比较两组受检者HR-ARM特征和盆底sEMG特征，包括肛管静息压、肛管最大缩榨压、直肠排便压、肛管残余压、最小松弛容积、直肠初始感觉阈值、直肠排便感觉阈值、直肠最大耐受阈值、前静息状态平均值、前静息状态变异性、快速收缩阶段最大值、快速收缩阶段放松时间、紧张收缩阶段平均值、紧张收缩阶段变异性、耐久收缩阶段平均值、耐久收缩阶段变异性、后静息状态平均值及后静息状态变异性等。结果 FDD组肛管静息压、肛管最大缩榨压、直肠排便压、直肠初始感觉阈值均低于对照组（P均<0.05），肛管残余压、直肠排便感觉阈值、最小松弛容积均高于对照组（P均<0.05）。FDD组前静息状态平均值、快速收缩阶段最大值、紧张收缩阶段平均值、耐久收缩阶段平均值、后静息状态平均值低于对照组（P均<0.05），紧张收缩阶段变异性、耐久收缩阶段变异性、快速收缩阶段放松时间均高于对照组（P均<0.05）。结论 女性FDD患者存在肛门直肠动力不足、直肠低敏感与盆底肌耐力下降、稳定性差以及功能协调障碍等盆底功能异常特征。应用HR-ARM与盆底sEMG检查能够比较全面的反映女性FDD患者的盆底功能障碍。

Objective To summarize the characteristics of pelvic floor dysfunction in female patients with functional defecation disorder(FDD) based on high-resolution anorectal manometry(HR-ARM) and pelvic floor surface electromyography(sEMG), in order to provide clinical guidance for treatment. Methods Sixty-four female patients with FDD were included in the FDD group, and 60 healthy female volunteers were recruited as the control group. All participants underwent HR-ARM and pelvic floor sEMG examinations. The parameters including anal resting pressure, maximum anal squeeze pressure, rectal expulsion pressure, residual anal pressure, minimum relaxation volume, rectal threshold for first sensation, rectal threshold for defecatory desire, rectal maximum tolerable threshold, anterior resting mean, anterior resting variability, maximum value during rapid contraction, relaxation time during rapid contraction, mean value during tonic contraction, variability during tonic contraction, mean value during endurance contraction, variability during endurance contraction, posterior resting mean, and posterior resting variability were recorded and compared between these two groups. Results Compared with the control group, the FDD group showed significantly lower anal resting pressure, maximum anal squeeze pressure, rectal expulsion pressure, and rectal threshold for first sensation(all P<0. 05), while had higher residual anal pressure, rectal threshold for defecatory desire, and minimum relaxation volume(all P<0. 05). In sEMG parameters, the FDD group demonstrated significantly lower anterior resting mean, maximum value during rapid contraction, mean value during tonic contraction, mean value during endurance contraction, and posterior resting mean(all P<0. 05), but had higher variability during tonic contraction, variability during endurance contraction, and relaxation time during rapid contraction than the control group(all P<0. 05). Conclusions Female patients with FDD present with multiple pelvic floor dysfunction characteristics, including inadequate anorectal dynamics, rectal hyposensitivity, decreased pelvic floor muscle endurance, reduced stability, and impaired functional coordination. Combined application of HR-ARM and pelvic floor sEMG provides a more comprehensive evaluation of pelvic floor dysfunction in female FDD patients.