The Clinical Utility Of Colonic And Anorectal Manometry In Chronic Functional Constipation

BackgroundChronic functional constipation is a common functional intestinal motility disorder,which is divided into slow transit constipation(STC),outlet obstruction constipation(OOC)and mixed constipation.Detection of intestinal motility and sensory function assessment of the diagnosis and treatment of the disease is very important.Colonic and anorectal manometry imported from abroad recent years have potential clinical value in the diagnosis of chronic functional constipation.The principal of colonic and anorectal manometry is that the pressuer on the manometric catheter is transferred into the digital signal by a converter.Then the data is managed by a special software.The motion information of different part of colonic and anorectal canal is calculated,which is important for diagnosis and evaluation of chronic functional constipation.Clinically,some STC patients often have a history of abdominal pain.This type of STC is classified into spastic contraction STC in accordance with the bowel movement pattern.Surgical removal of diseased bowel is the ultimate treatment of the disease.However,the determination of the extent of resection requires reliable preoperative examination to evaluate the location.In addition,the common disease in OOC needs surgical treatment.Nowadays,the curative effect of transanal stapler surgery is not the same.This requires an objective means to evaluate.Colonic and anorectal manometry is efficient and objective enough to meet the previous needs.This equipment has potential application value in diagnosis and treatment of chronic functional constipation.Aim1.To localize the spastic segment of STC colon by using the colonic manometry.To determine the extent of colectomy.To evaluate the clinical value of colonic manometry by comparing with pathological results.2.To study the correlation between the expression of differential protein and the frequency of non rhythmic contractionwaves in diseased bowel.To investigate the mechanism of the occurrence of spastic contraction in deseased bowel.3.To evaluate the anal sphincter function after the transanal stapler surgery for OOC by using the anorectal manometry,and compared with the constipation incontinence scale.To enaluate the clinical effect of the operation.To test the clinical value of the anorectal manometry.Method60 cases of spastic STC patients and 46 cases of OOC patients in our hospital from 2014 to 2015 were selected as the subjects of this study.Before the operation,STC patients underwent the colonic manometry and the OOC patients underwent the anorectal manometry.The extent of surgical resection of colon was determined according to the result of colonic manometry.Compared to the result of pathology,significance of preoperative colonic manometry was evaluated.Immunohistochemical staining of NSE and S-100 was performed on the spastic intestinal specimen.To analysis of the correlation between positive staining results and spastic contraction wave.Result1.The result showed that the spastic segment of the colon evaluated by colonic manometry was consistent with the pathological diagnosis.2.There was a negative correlation between the frequency of non rhymic contraction wave and the number of ganglion cells.3.The effect of transanal stapler surgery for OOC was accurate though the assessment from the anorectal manometry.The results of the assessment are consistent with the results of the relevant assessment scales.Conclusion1.Colonic manometry is of great significance in the diagnosis and evaluation of diseased bowel from STC.2.The reduction of ganglion cells may be related to the frequency of non rhymic contraction wave.3.The effect of transanal stapler surgery for OOC was accurate.Anorectal manometry is of practical value in the evalution of anal surgery.