진행성 전신성 경화증 환자에서의 항문직장 내압검사를 이용한 항문직장 기능 연구
Manometric Investigation of Anorectal Dysfunction in Patients with Progressive Systemic Sclerosis
최홍조, 임현성, 박기재, 정원태, 이성원,
소속 상세정보
최홍조 ( Choi Hong-Jo )
동아대학교 의과대학 외과학교실
임현성 ( Lim Hyun-Sung )
동아대학교 의과대학 외과학교실
박기재 ( Park Ki-Jae )
동아대학교 의과대학 외과학교실
정원태 ( Chung Won-Tae )
동아대학교 의과대학 내과학교실
이성원 ( Lee Sung-Won )
동아대학교 의과대학 내과학교실
KMID : 0356720020180020083
Abstract
Purpose: The aim of this study was to investigate the anorectal function in patients with progressive systemic sclerosis (PSS), thus to define the clinical role of anorectal manometry in the earlier diagnosis of anorectal involvement of
PSS.
Methods: Seventeen consecutive patients (all females) with PSS were evaluated with anorectal manometry by the stationary pullthrough technique using the 8-channel hydraulic capillary infusion system for anorectal function. Functional parameters of the manometry were compared between patients with PSS and 20 normal control subjects, matched for age and sex.
Results: The mean resting pressure over the high pressure zone (HPZ) in patients with PSS was significantly lower than that in the control group (70.8±3.4 ㎜Hg vs. 81.5±3.2 ㎜Hg: P=0.046). The HPZ in patients with PSS was also significantly reduced compared with that in the control (1.5±0.1 ㎝ vs. 2.5±0.1 ㎝: P=0002). The rectoanal inhibitory reflex (RAIR) was detected in only 10 patients (59%) in the PSS group, but was present in all except one (95%) in the control (P=0.022). More interestingly, RAIR in patients with PSS responded at a higher volume of the air insufflated than that in the control (74% vs. 30% at 20 ㏄, 21% vs. 30% at 30 ㏄, and 0% vs. 40% at 50 ㏄, respectively: P=0.031). Other functional parameters, including maximal squeeze pressure, minimal sensory and maximal tolerable volume of the rectum, and rectal compliance were not significantly different between two groups.
Conclusions: Anorectal involvement reflected by the anorectal manometric dysfunction may be rather an earlier event in patients with PSS. An awareness to perform an anorectal manometric study in every case of PSS may be
necessary for earlier subclinical detection of anorectal involvement by the disease.
키워드
진행성 전신성 경화증;항문직장 내압검사;직장항문억제반사
Progressive systemic sclerosis;Anorectal manometry;Rectoanal inhibitory reflex
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