| Constipation is characterized by reduced frequency of defecation,dry stool and/or difficulty in defecation.The course of CC is at least 6 months.The prevalence of CC is on the rise.Moreover,due to the diversity of the pathogenesis of chronic constipation,the effect of simple use of prokinetic drugs or laxatives is sometimes not good,and its safety is relatively poor.Patients spend a lot of time and money in the treatment process,However,the patient’s condition has not been very good improvement.According to the different etiology,constipation can be divided into two types:one is primary constipation(FC),the other is secondary constipation(caused by organic diseases and/or drugs);With the development of science and technology,many new technologies have emerged to help clinicians diagnose constipation.High resolution anorectal manometry(HR-ARM)has been used as a common detection method in the diagnosis of patients with constipation,including the detection of anorectal motility and sensation,It can be used to evaluate whether there are abnormalities in the physiological structure and function of rectum and anus,and it is very important for the evaluation of rectum and anus function,the diagnosis and classification of constipation,the correct choice of treatment methods for constipation,and the evaluation of treatment effectiveness.The first part is the analysis of anorectal dynamic and sensory characteristics and the study of constipation symptoms in patients with chronic constipationResearch purposeThrough high-resolution anorectal manometry in patients with chronic constipation(CC),hr-arm manometry results of FC patients,chronic constipation patients with diabetes mellitus(DM)and healthy control group were analyzed and compared to understand anorectal dynamics and sensory function characteristics of CC patients,and the correlation between constipation symptoms of FC and DM patients and hr-arm examination results.Research methodsSolar GI gastrointestinal dynamic examination system(MMS company,the Netherlands)was used.According to the inclusion criteria,the patients were divided into functional constipation group(FC group),chronic constipation group with diabetes mellitus(DM group)and healthy control group(H Group),Then the pressure measurement results of the three groups were compared and analyzed,and the constipation symptoms of patients with chronic constipation were scored and compared through the design of constipation symptom scale.The main indexes included anal resting pressure(IASP),rectal resting pressure(RRP),anal length(hpz),maximum anal systolic pressure(AMSP),rectal discharge pressure(RSP),anal residual pressure,duration of maximum anal squeezing pressure,anal relaxation rate(acrR),minimum relaxation volume(MRV),rectal sensory tolerance capacity(FSV),rectal initial sensory capacity(FSV),anal relaxation rate(acrR),rectal relaxation rate(MRV),and rectal sensory tolerance capacity(RSV)The first defecation sensation volume,strong defecation intention volume and maximum tolerated volume(MTV)of rectum were measured.Research results1.There were significant differences in ARP,acrR and DSS among DM group,FC group and H group(P<0.05).The anal residual pressure and duration of anal squeezing in DM group were higher than those in FC group,while acrR in FC group and DM group was lower than that in H group;There was no significant difference in IASP,RRP,hpz,RSP and MRV among DM group,FC group and H group(P>0.05).2.There was significant difference in rectal sensation among the three groups(P<0.05).The initial sensory capacity,first defecation capacity,strong defecation capacity and maximum tolerated capacity of DM group and FC group were higher than those of H group,and DM group was also higher than FC group,with more significant sensory abnormality.3.Compared with FC group,DM group was more prone to dry stool,FC group was more prone to defecation difficulty,with statistical difference(P<0.05)There was no significant difference in the frequency of defecation in every 24 hours(P>0.05).Conclusion1.Comparing the results of hr-arm examination between patients with chronic constipation and healthy people,the pathogenesis of CC is related to insufficient rectal propulsion,poor anal relaxation,increased anal residual pressure and high rectal tolerance.2.The constipation symptoms of DM patients with constipation are mainly dry stool,DM will aggravate anorectal motility and sensory abnormalities.3.The main symptom of FC constipation is defecation difficulty,and its pathogenesis is related to anorectal abnormal movement and elevated sensory threshold.The second part is the correlation between hr-arm results and FC classification and constipation symptomsResearch purposeObjective to study the correlation between the results of high-resolution anorectal manometry and the classification and symptoms of functional constipation,so as to help clinical diagnosis and classification of constipation and provide individualized treatment.Research methodsAccording to Rao SSC classification criteria,subjects in FC group were divided into anorectal movement coordination group(fc-n group)and anorectal abnormal movement group(fc-d group).Fc-n group:the anal pressure decreased,the rectal pressure increased(>45mmhg)and the anal canal relaxed(relaxation rate>20%);Fc-d group:the remaining subjects in FC group.The constipation symptom scale scores and hr-arm results of the two groups were compared.According to Rao SSC standard,anorectal abnormal motion can be divided into type I,type II,type III and type Ⅳ,and the proportion of each type was counted.The constipation symptom scale was designed,and all constipation patients filled in the symptom scale,and the comparison between fc-d group arid fc-n group was analyzed.The pressure measurement index is the same as the first part.Research results1.A total of 71 patients with FC in this study were detected by high-resolution anorectal manometry,including 16 patients(22.5%)in fc-n group,55 patients(77.5%)in fc-d group.In fc-d group,there were 6 patients(8.4%)with insufficient rectal propulsion,21 patients(29.5%)with type Ⅰ,9 patients(12.6%)with type Ⅱ,16 patients(22.5%)with type Ⅲ and 3 patients(4%)with type Ⅳ.2.This study found that fc-n group and fc-d group were more prone to reduce the number of defecation than fc-d group,and fc-d group was more prone to defecation difficulty and time-consuming than fc-n group(P<0.05)There was no significant difference in the frequency of incomplete defecation,abdominal distension,dry stool,failure of defecation in 24 hours and abdominal pain(P>0.05).Conclusion1.This study found that the FC patients in this experiment mainly had anorectal abnormal movement,mainly type Ⅰ and type Ⅲ.2.The constipation patients with anorectal abnormal movement as the main manifestation take more time to defecate,the number of attempts to defecate is increased,and there are more symptoms,which can indicate defecation disorder constipation;The main symptom of constipation patients without anorectal abnormal movement is the reduction of defecation frequency,which may be mainly slow transit constipation.The results need to be further demonstrated. |
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