Characteristics of anorectal motility in elderly patients with functional defecation disorders / 中华老年医学杂志

Objective:To investigate the characteristics of anorectal dynamics in elderly patients with functional defecation disorders(FDD), and to provide a basis for their diagnosis, treatment and prevention.Methods:In this retrospective study, 226 patients with FDD receiving 3D high-resolution anorectal manometry were divided into an elderly group(93 cases)and a non-elderly group(133 cases). Results from anorectal manometry parameters were compared and analysis of patterns of anorectal pressure changes in elderly participants based on sex, the Bristol stool classification and clinical symptoms was conducted.Results:The resting anal pressure, rectal pressure and anal relaxation rate were lower( t=-3.407, -2.051, Z=2.548, P=0.001, 0.040, 0.011)and the volume of first sensation was higher( t=1.998, P=0.047)in the elderly group than in the non-elderly group.The maximum anal squeezing pressure, residual anal pressure and maximum tolerated volume were higher( t=4.589, 4.730, 2.025, all P<0.05), whereas the anal relaxation rate and anorectal pressure gradient were lower in elderly men than in elderly women( Z=4.059, t=-3.714, P<0.001 for both). Regarding the types of FDD, both the elderly group and the non-elderly group were dominated with type Ⅱ defecation disorder, with more men than women having type Ⅱ defecation disorder in the elderly group( χ2=10.343, P=0.001). In cases of paradoxical sphincter contraction during simulated defecation, the incidence in the elderly group was 80.65%(75/93), which was higher than 68.42%(91/133)in the non-elderly group( χ2=4.194, P=0.041). The volume of first sensation, volume of first defecation sensation, and maximum tolerated volume of patients in the elderly group without the urge to defecate were(59.86±23.84)ml, (96.76±34.61)ml, and(144.32±30.57)ml, respectively, higher than those of patients with the urge to defecate(46.79±17.20)ml, (75.26±28.75)ml, and(120.00±40.28)ml( t=-2.241, -2.493, -2.891, P=0.027, 0.014, 0.005). The rectal pressure(26.52±16.08)mmHg of patients with defecation dyssynergia was lower than that of patients without defecation dyssynergia(39.91±8.82)mmHg(1 mmHg=0.133 kPa)( t=-3.128, P=0.002), while the resting anal pressure of patients with defecation dyssynergia(90.60±28.44)mmHg was higher than that of patients without defecation dyssynergia(73.65±27.10)mmHg( t=-2.201, P=0.030). The resting anal pressure and maximum anal squeezing pressure in patients with anal blockage sensation[(87.11±24.64)mmHg, (149.28±48.29)mmHg]were higher than those in patients without anal blockage sensation[(72.43±20.02)mmHg, (121.76±26.35)mmHg]( t=2.954、3.066, P=0.004、0.003). There was no significant difference in values from parameters of anorectal dynamics between patients with different Bristol stool types, with and without incomplete defecation or with different degrees of abdominal distension(all P>0.05). Conclusions:Anorectal dynamics in patients with FDD are characterized by paradoxical anal sphincter movements, but older patients with FDD are mainly characterized by inadequate rectal propulsion, pelvic floor muscle dysfunction and reduced rectal sensitivity.

Dyschesia and changes of pubo-rectal angle as observed by 3D ultrasound / 中华普通外科杂志

Objective To discuss the relativity of dyschesia with the change of puborectalismuscle.Methods 68 patients with dyschesia were compared with 68 healthy volunteers at lithotomy position undergoing 3D ultrasonography on resting,contracting and maximum exertion phase respectively.Three dimensionally reconstructed images were reconstructed and pubo-rectal angle and the thickness of puborectalis muscle at 6 o'clock position were measured.Results The pubo-rectal angle of the study group and control group had no significant differences at either resting [(86 ± 8) ° vs.(86 ± 8)°] or contracting phases [(88 ± 9) ° vs.(86 ± 7) °] (t =-0.145,t =0.434,P ＞ 0.05).While at maximum exertion the differences were significant [(80 ± 6) °vs.(95 ± 5) °,t =-5.397,P ＜ 0.05].The d-value of pubo-rectal angle between maximum and resting exertion statistically different [(6 ± 3) °,(-9 ± 7) °,t =5.551,P ＜ 0.05].The thickness of puborectalis muscle between the two groups differed statistically significant only at maximum exertion phase [(4.60 ± 0.60) mm vs.(3.97 ± 0.32) mm,t =6.872,P ＜ 0.05].The d-value of the thickness of puborectalis muscle between maximum and resting exertion were statistically different (t =-11.474,P ＜ 0.05).Conclusions The pubo-rectal angle of the study group is smaller at maximum exertion than the control group.The thickness of puborectalis muscle at six o'clock (lithotomy position) in study group is larger at maximum exertion than the control group.And the severity of constipation changed with the variation of angle.

Association between abnormalities of the distal rectal pouch and postoperative bowel function in high or intermediate anal atresia / 中华普通外科杂志

Objective To evaluate wall histological abnormalities 2 to 3 cm to the end in high or intermediate anal atresia in order to identify features that explain postoperative bowel dysfunctions.Methods Sixty anal atresia patients treated in the Capital Pediatric Institution between January 2008 and December 2012 were recruited in our study.36 patients were resected the terminal anal segment (3 cm).Compared with those 24 cases who were not.Resected samples were fixed for HE and immuno-histochemical stainings.Clinical data including sacral ratio (SR),age at operation,gender,bowel function were evaluated.Results There was no significant difference in patients' SR value,gender and age at operation between resected group and control group.The median follow-up period was 4.5 years.The rates of voluntary bowel movement,soiling (grade 1,2,3) were similar in both groups,however,the rates of severe constipation in resection group was significantly lower that in control group (3 ％ vs.21％,P ＜ 0.05) In the bowel wall of distal 2 cm anrectal canal,the connective tissue was found to be irregular and abnormally represented.Muscle coat was abnormal in all cases,showing the dysplasia circular and longitudinal layers.The number of enteric nervous system was significant fewer in distal 2cm anrectal canal than that in distal 3 cm(1.6 ±0.9 vs.5.6 ±1.8,t=11.715,P＜0.01).Conclusions Resection of terminal 3 cm at least of the atresia anal canal benefits postoperative bowel defecation function.

Analysis of anorectal manometry in 40 women with posterior vaginal prolapse / 中华妇产科杂志

Objective To study abnormal defecation in patients with posterior vaginal prolapse combined with anorectal manometry. Methods From Jan. 2008 to Nov. 2009, clinical documents and examination of anorectal manometry of 40 patients with posterior vaginal prolapse were studied retrospectively. Anal physiologic testing was performed for 40 patients. These patients were classified into group A ( stage 0 and [posterior vaginal prolapse, represented normal) and group B ( stage Ⅱ - Ⅳ ).Results of anorectal manometry, constipation and symptoms of defecation were compared. Results The average anal canal resting pressure and squeeze pressure of 40 patients were (40 ±21 ) and (96 ±33) mm Hg (1 mm Hg =0. 133 kPa). In group A, the anal canal resting pressure and squeeze pressure were (37 ±21) and (78 ±43) mm Hg, rectal sensation threshold and rectal maximum volume were (106 ±61 ) and (183 ± 51 ) ml. In group B, the anal canal resting pressure and squeeze pressure were (42 ± 21 ) and (102±30) mm Hg, rectal sensation threshold and rectal maximum volume were (90±44) and (171 ±61) nl.Apart from maximum squeeze pressure ( P = 0. 039 ), the other clinical index did not show statistical difference (P ＞ 0. 05 ). Rectal sensation threshold, intended volume and maximum capacity of (116 ± 69 ),( 170 ± 90), ( 191 ± 75 ) ml in patients with constipation were higher than (84 ± 31 ), ( 121 ± 37 ), ( 169 ±45) ml in patients without constipation. In addition to maximum capacity (P = 0. 281 ), the other clinical index reached statistical difference between patients with and without constipation (P ＜ 0. 05 ). Patients with defecation symptoms have higher rectal sensation threshold, intended volume and maximum capacity than those of patients without defecation symptoms. Conclusions As gradually increased in the degree of prolapse, resting pressure and squeeze pressure tend to be increased, while the rectal sensation threshold and rectal maximum volume tend to be decreased. Patients with defecation symptoms and constipation have increased the initial feeling of volume and maximum tolerated volume.

Inquisition on the pathogeny and treatment of anorectal malformation induced postoperative dysporia in children / 临床外科杂志

Objective To investigate the pathogeny,pathological characteristics and treatments of anorectal malformation induced postoperative dysporia in children.Methods Between January 1985 and December 1998,120 children with anorectal malformation were treated.Of thesepatients,follow-up has ranged 106 children(78 males,28 females),from 4 to 14 years (median,10 years).The ratio of follow-up was 80%.Results 38 patients were high-type anomalies (36%),and with postoperative dysporia (36%),32 patients were intermediate-type anomalies (30%),15 cases with postoperative dysporia (14%),36 patients were low-type anomalies (34%),6 cases with postoperative dysporia (6%).Conclusions Among the high anorectal malformation patients,no one reached normal fecal continence.This may be due to bony spinal deformities and variable degrees of neurologic deficit.Intermediate and low anorectal malformation induced postoperative dysporia may be associated with surgical techniques.The application of laparoscopic assisted techniques for high and intermediate anorectal malformation has led to dramatic improvement in postoperative dysporia.