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직장류 환자에서 직장 항문 기능검사의 특성과 임상적 의미

Rectocele-Anorectal Physiologic Characteristics and their Clinical Significances

대한대장항문학회지 1996년 12권 1호 p.19 ~ 30
김석균 ( Kim Seok-Kyun ) - 건국대학교 의과대학 외과학교실

박웅채 ( Park Ung-Chae ) - 건국대학교 의과대학 외과학교실

Abstract


With recent advances in the anorectal physiologic studies, development of extensive strategies made it possible to investigate the specific aspects of functional evacuation disorders more than ever. This study was designed to assess the associate physiologic findings of rectocele and their clinical significances for the therapeutic option. All patients who had a history of chronic constipation for more than 6 months were referred to the anorectal physiologic unit. Physiologic findings of thirty seven patients who had pelvic outlet obstruction were reviewed. In cinedefecography, significant rectocele was
defined as a poor rectal emptying of barium paste from the bulged outpocket of anterior rectum and more than 3 cm in its size, simultaneouly. Defenition of anal hypertonia included when mean and maximum resting pressures were one standard deviation higher than those in age matched controls(n=33). According to these criteria, 14 significant
rectocele were selected and focused on the rectocele associated functional disorders. 37 pelvic outlet obstruction patients were categorized as presence of significant rectocele(group A; n=14) and nonsignificant rectocele or absence of rectocele group(group B: n=23). Manometric, defecographic and neurologic(pudendal latency and anal EMG) findings were compared between group A and B. Treatment outcome was subjectively evaluated by questionnaire with daily log(n=26) and objectively by post-treatment cinedefecography(n=10). Group A showed more frequent anal hypertonia than that of group B(group A; 8/14 vs. group B; 3/23, p=0.008, Fisher’s exact test). When we compared the value of pudendal latency and anal EMG findings, no significant differences were noticed between group A and B. In group 4, patients with anal hypertonia were performed transanal ectocele repair with total internal sphincterotomy(n=4), and transanal rectocele repair
with anorectal myectomy(n=4). 3 patients without associated functional disorders were performed transanal rectocele repair only. 2 patients with coexistent severe rectoanal intussusception were underwent Delorme’s operation. One patient with severe nonrelaxing puborectalis syndrome was performed manometric based biofeedback therapy. In group B, 3 patients with nonrelaxing puborectalis syndrome were underwent a mean of 6 sessions(range, 3∼8 sessions) of biofeedback therapy. Other patients(n=20) had conservative treatment such as high fiber diet and/or bulk laxatives. Regarding to treatment outcome, all cases of group A were followed up with a mean 5.2(range, 1-10) months duration. 12 of 14(85.7 percent) patients had successful outcome. 2 patients with major depression were failed in treatment. 12 of 23 patients in group B were followed up with 5.7(range, 1-12) months duration. 11 cases were lost in a period of follow-up.
10 of 12 patients(83.3 percent) had successful outcome. In conclusion, cinedefecography is an ideal objective method for the identification of significant rectocele. Associated functional disorders and their characteristic physiologic findings could be evaluated by anorectal physiologic investigations, and these are indispensable before considering treatment. These results provide a guidance for therapeutic option of rectocele.

키워드

Defecography;Manometry;Rectocele
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