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題名 | Anorectal Manometric Study of Patients with Long Term Diabetes Mellitus=長期糖尿病患者之直腸肛門壓力研究 |
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作者姓名(中文) | 林楨國; 翁錦興; | 書刊名 | 中華民國大腸直腸外科醫學會雜誌 |
卷期 | 12:1 2001.03[民90.03] |
頁次 | 頁1-6 |
分類號 | 416.245 |
關鍵詞 | 糖尿病; 直腸肛門壓力; Anus; Incontinence; Diabetes mellitus; Manometry; |
語文 | 英文(English) |
中文摘要 | 長期糖尿病患者常有肛門失禁現象。其肛門失禁之機轉及原因有各種說法,各家意見也不一致。本研究之目的即在探討長期糖尿病人肛門失禁之機轉及可能原因。 三十位罹患糖尿病十年以上之患者接受臨床評估,並測量其直腸肛門之各種生理參數。三十人中有十七位有各種不同程度之肛門失禁,另十三位則無此症狀。另外選擇十五位年齡、性別相近之非糖尿病患者,測其直腸肛門參數作為比較。 結果顯示長期糖尿病人之肛門靜止壓力,直腸感覺及最大容量均顯著低於正常人。而同樣糖尿病患者有肛門失禁者,其肛門靜止壓、收縮壓、直腸感覺容量均較無失禁者顯著低。研究顯示長期糖尿病者可能因肛門內或外括約肌壓力減弱,直腸敏感度增加而導致肛門失禁。 |
英文摘要 | PURPOSE: Fecal incontinence in long term diabetes mellitus (DM) patients is not uncommon. The pathophysiology and causes of this complication of DM are not well realized, nor is there consistent agreement. Probable mechanisms reported include decreased resting or contraction pressure of anal sphincters, impaired rectoanal inhibitory reflex, increased or decreased compliance of rectal wall, change or delayed rectal sensitivity. The purpose of this study is to prospectively investigate the possible mechanism of anal incontinence in long-term DM patients. PATIENTS AND METHODS: Anorectal manometry was performed in 30 patients with DM for more than 10 years (16.7 ± 8.3, range 10-40). Seventeen of these had varying degrees of anal incontinence, while 13 did not. Fifteen non-DM patients who did not have abdominal or anorectal symptoms were selected as control group. Anorectal manometry was studied using a four-channel continuous water perfusing system, with station pull-through technique. RESULTS: The results showed that the maximal basal pressure (MBP) of DM patients was much lower than that of controls (48.2 ± 17.5 v.s. 65.3 ± 14.6 mmHg, p=0.0032). The volume of first rectal sensation (Vsense, 116.3 ± 55.7 v.s. 164.7 ± 71.9 ml, p=0.022), volume to initiate rectal urge (Vurge, 176.0 ± 52.8 v.s. 220.7 ± 62.6 ml, p=0.0244), and the maximal tolerable rectal capacity (Vmax., 237.7 ± 64.1 v.s. 286.7 ± 55.0 ml, p=0.0106) of the DM patients were lower than those of controls. In comparing DM patients with or without anal incontinence, the difference of the MBP, MCP, Vsense, and Vurge in the two groups was also significant.: MBP 42.4 ± 16.4 v.s. 55.8 ± 16.5 mmHg, p=0.002; MCP 123.4 ± 57.7 v.s. 174.9 ± 47.8 mmHg, p=0.0341; Vsense 104.1 ± 66.9 v.s. 132.3 ± 32.2 ml, p=0.0157; Vurge 167.1 ± 62.9 v.s. 187.7 ± 34.4 ml, p=0.0502. There was no significant difference among the DM continent, DM incontinent patients and the controls in terms of the functional length of sphincter, compliance of rectal wall and the percentage deflection of basal pressure during recto-anal inhibitory reflex. CONCLUSIONS: We conclude that in long term DM patients, anal incontinence is caused by the decrease of internal sphincter pressure, probably decreased external anal sphincter tone and increased irritability of rectal wall, which probably are initially caused by degeneration of autonomic and/or somatic nervous system. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。