背景:几乎没有数据评估3维高清肛门直肠测压(3D-HDAM)系统在协同排便障碍诊断中的性能。较厚的物理性质,刚性,3D-HDAM探针可能对肛门直肠压力的测量具有影响。
目的:我们的目的是比较3D-HDAM与球囊排出试验和磁共振(MR)排粪造影。
方法:连续便秘患者在卡尔加里肠动力中心进行肛门直肠功能测试(卡尔加里,加拿大)在2014年至2019年之间进行了评估。所有患者均使用3D-HDAM探头进行肛门直肠测压,和一个子集接受BET或MR排粪造影。比较BET正常和异常患者的肛门直肠测压变量。
结果:在研究期间,81例患者因便秘症状同时接受了3D-HDAM和BET。52例患者在3分钟内排出球囊。BET异常患者的直肠肛门压差(RAPD)显着降低(-61vs.-31mmHg的正常BET,p=0.03)和排便指数(0.29vs.0.56,p=0.03)。在逻辑回归分析中,RAPD(OR:0.99,95%CI:0.97-0.99,p=0.03)仍然是BET异常的负预测因子。在ROC分析中,RAPD的AUC为0.65。在3D-HDAM上的协同失调模式和协同失调的排粪造影证据之间存在良好的一致性(敏感性80%,特异性90%,PLR9,NLR0.22,精度85%)。
结论:测压参数,当用3D-HDAM探头测量时,很难预测延长的气球排出时间。RAPD仍然是延长球囊排出时间的最佳预测指标。3D-HDAM探针可能不是诊断功能性排便障碍的理想工具。
BACKGROUND: There are little data evaluating the performance of the 3-dimensional high-definition anorectal manometry (3D-HDAM) system in the diagnosis of dyssynergic defecation. Physical properties of the thicker, rigid, 3D-HDAM probe may have implications on the measurements of anorectal pressures.
OBJECTIVE: Our aim was to compare 3D-HDAM to balloon expulsion test and magnetic resonance (MR) defecography.
METHODS: Consecutive constipated patients referred for anorectal function testing at the Calgary Gut Motility Centre (Calgary, Canada) between 2014 and 2019 were assessed. All patients underwent anorectal manometry with the 3D-HDAM probe, and a subset underwent BET or MR defecography. Anorectal manometric variables were compared between patients who had normal and abnormal BET.
RESULTS: Over the study period, 81 patients underwent both 3D-HDAM and BET for symptoms of constipation. 52 patients expelled the balloon within 3 minutes. Patients with abnormal BET had significantly lower rectoanal pressure differential (RAPD) (-61 vs. -31 mmHg for normal BET, p = 0.03) and defecation index (0.29 vs. 0.56, p = 0.03). On logistic regression analysis, RAPD (OR: 0.99, 95% CI: 0.97-0.99, p = 0.03) remained a negative predictor of abnormal BET. On ROC analysis, RAPD had an AUC of 0.65. There was good agreement between dyssynergic patterns on 3D-HDAM and defecographic evidence of dyssynergia (sensitivity 80%, specificity 90%, PLR 9, NLR 0.22, accuracy 85%).
CONCLUSIONS: Manometric parameters, when measured with the 3D-HDAM probe, poorly predict prolonged balloon expulsion time. RAPD remains the best predictor of prolonged balloon expulsion time. The 3D-HDAM probe may not be the ideal tool to diagnose functional defecatory disorders.