만성 변비의 진단을 위한 대장항문 기능검사의 역할
A Role of Anorectal Physiologic Study for the Diagnosis of Chronic Constipation
김승한, 황용희, 최건필,
소속 상세정보
김승한 ( Kim Seung-Han )
서울위생병원 일반외과
황용희 ( Hwang-Young-Hee )
서울위생병원 일반외과
최건필 ( Choi Gun-Phil )
서울위생병원 일반외과
KMID : 0356720000160040231
Abstract
Purpose: To assess the role of anorectal physiologic study for the diagnosis of chronic idiopathic constipation.
Methods: A retrospective study of 81 constipated patients (23 male, 58 female) of mean age 48 16.6 (16∼83) years who had no abnormalities in colonoscopy, barium enema, and rectal exam was done. 81 patients underwent defecography and cine-defecography, of which 66 patients underwent anal manometry, 52 patients underwent colonic transit time study (CTT), and 27 patients underwent anal plug electromyography (EMG).
Results: Nonrelaxing puborectalis syndrome (NRPR), rectocele, rectal intussusception, anal dyschezia, and sigmoidocele were observed in 27 (33.3%), 26 (32.1%), 14 (17.3%), 3 (3.7%), and 2 (2.5%) of the patients, respectively. Normal cinedefecography finding was observed in 21 (25.9%) patients. More than one abnormal finding was found in 11
(13.6%) patients. Abnormal findings included colonic inertia in 6 (11.5%) patients and pelvic outlet obstruction in 2 (3.8%) patients. Normal colon transit time was observed in 44 (84.6%) patients. Anal hypertonia was observed in 23 (34.8%) patients by anal monometry, of which 3 patients were diagnosed with anal dyschezia in cinedefecography. 13 (48.1%) patients were diagnosed with NRPR in anal plug EMG. The correlation rate between cinedefecography/EMG, defecography/CTT, and CTT/EMG were 81.5%, 61.5%, and 51.9% respectively in the diagnosis of NRPR. Sensitivities of the three tests were 72.7% for cinedefecography, 66.7% for EMG, and 7.7% for CTT in diagnosing NRPR (p＜0.05). Positive predictive values of the three tests were 80% for anal plug EMG, 72.7% for cinedefecography, and 50% for CTT in the diagnosis of NRPR.
Conclusion: Defecography and EMG were complements each of the other in diagnosis of pelvic outlet obstruction especially NRPR, but CTT has no role.
키워드
변비; 배변조영술;대장통과시간 측정술;근전도 검사;치골직장근 이완부전증
Constipation;Defecography;Colon transit time;Electromyography;Non-relaxing puborectalis syndrome
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