| ObjectiveAnorectal manometry is one of the most important anorectal function testing technique. The application of vector manometry is not consistent in different studies, it still remains to be substantiated by data. The study was designed to evaluate its relationship with fecal incontinence and idiopathic constipation in a retrospective way. On the other hand, on the experimental models of EAS injure and anorectum malposition, the values of vectometry and feces control capability were recorded and analyzed in a perspective way.MethodsThe clinical values of vectormanometry were discussed in a random control study among control, idiopathic constipation and congenital anorectal malformation groups. 24 controls, 21 idiopathic constipations and 22 imperforate anuses were studied by the continuous pull-through technique, the correlation between the clinical score and vector manometry were reported.On the mongrel dogs models, the data of vectography and defecation control capability are analyzed among controls, EAS injures and anorectum malpositions. 12 dogs are studied preoperatively, after the injure of EAS laterally, and after malposition of the anorectum. The defecation habits are observed 3 months after the operation.With the statistical software of STATA 7.0, F tests or student t tests wereperformed on the norm variablies, Wilcoxon-Mann-Whitney or Kruskal-Wallis rank tests had been done on the non-norm distribution data. A p-value of less than 0.05 was considered to be statistically significant.ResultsClinical studies demonstrated that the group of imperforate anus decreased in MRAP and MSAP and in MRVV and MSVV compared with the control. The fair group had a bigger MRVV, MSVV, MRAP and MSAP, a smaller SAI compared with the poor group. A positive Spearman correlation coefficient existed between the clinical score and MRVV or MSVV. MSAP bigger than MRAP, MSVV larger than MRVV, squeezing SAI smaller than resting SAI were found in the three groups. In the fair group, the MSVV was more than 129 cm*(cmHg)2 and squeezing SAI less than 37%.The animal models showed the injure group had a smaller MRAP and MSAP, a longer squeezing sphincter length, with resting sphincter length not different compared with the control. The malposition group had a smaller MSAP, with MRAP less than the control but not statistically different with the injure group. The rate of RAIR was 83.3% in control group, 41.7% in injure group and 16.7% in malposition group, difference existed among the groups. The injure group got a smaller MRVV and MSVV, a bigger resting and squeezing SAI. The malposition group had a smaller MRVV and MSVV, a bigger SAI than the control, not different with the injure. No defecation habits change existed in the injure-sutured group after the operation, but constipation and incontinence appeared in the malposition group. In the diagnosis of pressure defects with the vector volume 3D image, the sensitivity was91.7%, the specificity 100% in the injure group. The sensitivity and the specificity were 100% in the malposition group.ConclusionsVector manometry is a new part of anorectal manometry, the vector volume 3D image is constructed on the basis of pressures in the whole anal canal, reflecting the longitudinal gradient and cross-section asymmetry, and can be classified into 3 types-bell, bell-like and irregularity. A fair continence should not have a SAI bigger than 37%.Vector manometry can offer qualitative and quantitative assessment in the incontinence and constipation situation. A positive Spearman correlation coefficient(R=0.6017, P=0.0145) existed between the clinical score and MSVV in the incontinence group. VVM decreases and SAI increased in incontinence situation. A MSVV bigger than 129 cm*(cmHg)2 was necessary in the fair group.The vector volume 3D image is reliable in the diagnosis of sphincter defects. A local defect and an increased SAI will appear in an EAS defect, the sensitivity is 91.7% and the specificity 100%.The value of vector manometry is con...
|
PDF Full Text Request