摘要目的:比较出口梗阻型便秘(OOC)与非OOC患者的高分辨率肛门直肠测压结果，探讨肛门直肠动力异常和直肠感觉功能障碍在OOC发病中的作用。方法:回顾性分析2018年1月至2019年7月于首都医科大学附属北京同仁医院消化内科就诊的103例功能性便秘患者的高分辨率肛门直肠测压检查结果，根据诊断标准将其分为OOC组(56例)和非OOC组(47例)。比较OOC组与非OOC组患者的一般资料(年龄、性别构成)，以及肛门直肠动力(肛管静息压、肛门括约肌长度、肛管最大收缩压、肛管持续收缩时间、肛门残余压和直肠排便压)和直肠感觉功能(初始感觉阈值、初始排便阈值和最大耐受阈值)指标。统计学方法采用配对 t检验和卡方检验。 结果:OOC组患者的年龄与非OOC组比较[(63.5±14.2)岁比(61.6±13.4)岁]，差异无统计学意义( P>0.05)；OOC组的男性比例高于非OOC组[41.1%(23/56)比23.4%(11/47)]，差异有统计学意义( χ2＝-3.607， P<0.05)。OOC组患者的肛管静息压、肛门括约肌长度、肛管最大收缩压、肛管持续收缩时间、初始感觉阈值、初始排便阈值和最大耐受阈值与非OOC组比较[(71.77±26.28) mmHg比(69.98±24.18) mmHg(1 mmHg＝0.133 kPa)、(4.13±4.10) cm比(3.51±0.74) cm、(170.75±51.13) mmHg比(175.50±64.80) mmHg、(18.44±7.27) s比(16.39±7.98) s、(55.96±40.90) mL比(47.70±24.77) mL、(77.13±39.97) mL比(77.11±36.12) mL、(133.92±62.85) mL比(142.15±48.68) mL]，差异均无统计学意义( P均>0.05)；OOC组患者的排便时肛门残余压和直肠排便压均高于非OOC组[(67.00±21.13) mmHg比(51.43±0.74) mmHg、(51.52±23.70) mmHg比(36.49±12.55) mmHg]，差异均有统计学意义( t＝-3.734、-3.909， P均<0.01)。OOC组和非OOC组中直肠感觉功能障碍者分别占46.4%(26/56)和51.1%(24/47)。 结论:OOC患者普遍存在肛门直肠动力异常和直肠感觉功能障碍，其中排便时肛管松弛不足可能是OOC特有的重要的发病相关因素。

abstractsObjective:To Compare the results of high-resolution anorectal manometry (ARM) between patients with outlet obstruction constipation (OOC) and patients without OOC, and to explore the role of abnormal anorectal motility and rectal sensation in the pathogenesis of OOC.Methods:From January 2018 to July 2019, the results of ARM of 103 patients with functional constipation from the Department of Gastroenterology, Beijing Tongren Hospital Affiliated to Capital Medical University were retrospectively analyzed. According to the diagnostic criteria, the patients were divided into OOC group ( n=56) and non-OOC groups ( n=47). The general data (age and gender composition), anorectal motility (anorectal resting pressure, anal sphincter length, maximum squeeze pressure, duration of anal continuous contraction, residual anal pressure and rectal defecation pressure) and rectal sensation (rectal initial sensation threshold, initial defecation threshold and maximum tolerable volume threshold) were compared between OOC group and non-OOC group. Paired t test and chi-square test were used for statistical analysis. Results:There was no statistically significant difference in age between OOC group and non-OOC group ((63.5±14.2) years old vs. (61.6±13.4) years old, P>0.05). The proportion of male of OOC group was higher than that of non-OOC group (41.1%, 23/56 vs. 23.4%, 11/47), and the difference was statistically significant ( χ2=-3.607, P<0.05). There was no statistically significant differences in anorectal resting pressure, anal sphincter length, maximum squeeze pressure, duration of anal continuous contraction, rectal initial sensation threshold, initial defecation threshold and maximum tolerable volume threshold between OOC group and non-OOC group ((71.77±26.28) mmHg vs. (69.98±24.18) mmHg, 1 mmHg=0.133 kPa; (4.13±4.10) cm vs. (3.51±0.74) cm; (170.75±51.13) mmHg vs. (175.50±64.80) mmHg; (18.44±7.27) s vs. (16.39±7.98) s; (55.96±40.90) mL vs. (47.70±24.77) mL; (77.13±39.97) mL vs. (77.11±36.12) mL; (133.92±62.85) mL vs. (142.15±48.68) mL; all P>0.05). The residual anal pressure and rectal defecation pressure of OOC group were both higher than those of non-OOC group ((67.00±21.13) mmHg vs. (51.43±0.74) mmHg; (51.52±23.70) mmHg vs. (36.49±12.55) mmHg), and the differences were statistically significant ( t=-3.734 and -3.909, both P<0.01). The proportion of patients with rectal sensation of OOC group and non-OOC group was 46.4%(26/56) and 51.1%(24/47), respectively. Conclusions:Abnormalities of anorectal motility and rectal sensation are common in OCC patients, and insufficient anal relaxation during defecation may be an important pathogenic factor of OCC.