척수손상 환자에서 항문직장 내압검사의 유용성 평가

김동욱 ( Dong Uk Kim ),송근암 ( Geun Am Song ),김광하 ( Gwang Ha Kim ),허정 ( Jeong Heo ) 대한소화기기능성질환·운동학회 2009 Journal of Neurogastroenterology and Motility (JNM Vol.15 No.1

목적: 척수손상 환자에서 신경인성 방광은 잘 알려져 있으나 신경인성 장은 체계적인 연구가 부족한 편이다. 이에 저자들은 척수손상 환자에서 척수손상의 정도와 위치에 따른 항문직장 내압검사의 차이를 비교하고자 하였다. 대상 및 방법: 신경인성 장의 증상을 가지고 있는 25명의 척수손상 환자를 대상으로 항문괄약근 휴식압, 압착압 및 직장항문억제반사, 직장 감각능, 배변을 시도할 때 직장과 항문의 압력변화 등을 측정하였다. 결과: 완전 척수손상과 불완전 척수손상 환자군 및 T5 이상과 T6 이하 척수손상 환자군 사이에 최대 항문괄약근 휴식압, 최대 압착압, 항문직장억제반사를 유발하는 최소부피는 차이가 없었다. 완전 척수손상 환자군에서 불완전 척수손상 환자군에 비해 배변감(p =0.041)과 긴박한 배변감(p=0.047)을 느끼는 최소용적 및 최대인내용적(p=0.047)을 측정할 수 없는 경우가 의미있게 많았다. 그러나, T5 이상과 T6 이하 척수손상 환자군 사이에 직장 감각능의 유의한 차이는 없었다. 전체 척수손상 환자군에서 배변을 시도할 때 최대 직장압, 항문괄약근 이완율, 배변지수는 모두 정상범위 이하로 감소되어 있었다. 완전 척수손상과 불완전 척수손상 환자군 사이에 최대 직장압, 항문괄약근 이완율, 배변지수의 차이는 없었으며, T5 이상과 T6 이하 척수손상 환자군 사이에 최대 직장압과 배변지수는 차이가 없었으나 항문괄약근 이완율(-1.7±25.8% vs.22.7±18.4%)은 T5 이상 척수손상 환자군에서 유의하게 감소되어 있었다(p=0.046). 결론: 완전 척수손상 환자에서 외항문괄약근의 기능이 감소되어 상대적으로 변실금을 더 많이 호소하며, T5 이상 척수손상 환자에서 배변을 시도할 때 직장압력의 상승에 따른 항문괄약근의 유기적 이완이 되지 않아 변비를 더 많이 호소할 것으로 예상된다. Background/Amis: To evaluate the characteristics of anorectal manometry based on the level of spinal cord injury (SCI) in patients with neurogenic bowel. Methods: Twenty five patients with SCI were classified as complete or incomplete lesions according to severity, and ≥T5 or ≤T6 SCI according to the level of injury. We measured the maximum anal resting pressure (MARP), maximum squeezing pressure (MSP), threshold of rectoanal inhibitory reflex (RAIR), rectal sensations, and intraluminal pressure changes while patients were bearing down. Results: In patients with SCI the MARP, MSP, and RAIR were: 77.8±41.9 mmHg, 92.4±53.5 mmHg, and 26.0±14.1 mL respectively. In patients with complete lesions, the MSP/MARP and minimal volume for the RAIR were lower than in the patients with incomplete lesions (p=0.030, p=0.039 respectively). Rectal sensations were affected more frequently and completely in patients with complete lesions than in patients with incomplete lesions. Bearing down in patients with ≥T5 SCI was associated with a higher percentage of decreased anal relaxation than in those patients with ≤T6 SCI (-1.7±25.8 mmHg and 22.7±18.4% respectively). Conclusions: Patients with SCI had abnormal findings on anorectal manommetry. Patients with complete lesions had decreased voluntary contractions of the external anal sphincter resulting in fecal incontinence. In addition, patients with ≥T5 SCI had paradoxical contractions or inadequate relaxation of the internal anal sphincter when bearing down resulting in more severe constipation. (Kor J Neurogastroenterol Motil 2009;15:52-57)

선천성 거대결장증이 의심되는 12개월 이하의 영아에서 직장-항문 억제반사(Recto-anal inhibitory reflex)의 진단적 유용성 -선천성 거대결장증에서 직장-항문 억제반사의 진단적 유용성-

정수진 ( Su Jin Jeong ),서정기 ( Jeong Kee Seo ) 대한소화기기능성질환·운동학회 2003 Journal of Neurogastroenterology and Motility (JNM Vol.9 No.1

목적 : 선천성 거대결장증이 의심되는 신생아 및 어린 영아에서는 대장의 확대가 뚜렷하지 않아 이행부위를 명확히 발견하여 진단하는 것이 쉽지 않고 직장 압력 검사상 직장-항문 억제반사의 유무에 따른 진단적 정확도도 다양하게 보고되고 있다. 이에 저자들은 임상증상으로 선천성 거대 결장증이 의심되는 12개월 미만의 어린 영아에서 이행부위와 직장-항문 억제반사의 유용성을 알아보고자 본 연구를 시행하였다. 대상 및 방법 : 1999년 5월부터 2002년 7월까지 Background/Aims: It is difficult to clinically distinguish infants with Hirschsprung disease (HD) from those with other causes of intestinal obstruction. Therefore, reliable and safe diagnostic procedures are particularly necessary in infants with early o

진행성 전신성 경화증 환자에서의 항문직장 내압검사를 이용한 항문직장 기능 연구

최홍조,임현성,박기재,정원태,이성원 대한대장항문학회 2002 Annals of Coloproctolgy Vol.18 No.2

완전 직장탈 환자에서 변실금에 영향을 미치는 인자

윤서구,이광렬,김건욱,송석규,김칠석,이종균,김광연 대한대장항문학회 2001 Annals of Coloproctolgy Vol.17 No.1

항문직장내압 검사의 성별 및 연령에 의한 영향

허승철,강성범,박규주,박재갑 대한대장항문학회 2009 Annals of Coloproctolgy Vol.25 No.5

Purpose: This study was performed to evaluate the effects of age and sex on anorectal manometry. Methods: Seventy-four consecutive patients who underwent surgery for sigmoid colon cancer and who had neither anal disorders nor colonic obstruction were included in this study. There were 45 men and 29 women, and the mean age was 58.6. Pressure measurements used both the rapid and the station pull-through (RPT and SPT) methods, and volume measurements used a balloon-tipped catheter. Three pressure indices (vector volume, maximal pressure, and mean pressure), three sphincter length indices (sphincter length, high pressure zone [HPZ] length, and maximal pressure position), and three volume indices (minimal sensory volume, maximal tolerance volume, and rectoanal inhibitory reflex) were analyzed. Results: Squeezing pressures were higher in men than in women, especially in the RPT method, while resting pressures were not different. Sphincter length and HPZ length were not different between the sexes, but the maximal pressure position was farther from the anal verge in men. Rectal volume indices were not different between the sexes. The resting and squeezing pressures decreased linearly with aging in men, but not in women. The differences in squeezing pressures between men and women were evident in their forties and fifties, but decreased gradually with aging, with no differences being observed in their seventies. With aging, the minimal sensory volume increased in women, and the maximal tolerance volume increased in men. Conclusion: Anal canal pressures and volume indices are influenced by sex, age, and measurement method. Therefore, sex, age, and measurement method must be considered in the evaluation and application of anorectal manometry. Purpose: This study was performed to evaluate the effects of age and sex on anorectal manometry. Methods: Seventy-four consecutive patients who underwent surgery for sigmoid colon cancer and who had neither anal disorders nor colonic obstruction were included in this study. There were 45 men and 29 women, and the mean age was 58.6. Pressure measurements used both the rapid and the station pull-through (RPT and SPT) methods, and volume measurements used a balloon-tipped catheter. Three pressure indices (vector volume, maximal pressure, and mean pressure), three sphincter length indices (sphincter length, high pressure zone [HPZ] length, and maximal pressure position), and three volume indices (minimal sensory volume, maximal tolerance volume, and rectoanal inhibitory reflex) were analyzed. Results: Squeezing pressures were higher in men than in women, especially in the RPT method, while resting pressures were not different. Sphincter length and HPZ length were not different between the sexes, but the maximal pressure position was farther from the anal verge in men. Rectal volume indices were not different between the sexes. The resting and squeezing pressures decreased linearly with aging in men, but not in women. The differences in squeezing pressures between men and women were evident in their forties and fifties, but decreased gradually with aging, with no differences being observed in their seventies. With aging, the minimal sensory volume increased in women, and the maximal tolerance volume increased in men. Conclusion: Anal canal pressures and volume indices are influenced by sex, age, and measurement method. Therefore, sex, age, and measurement method must be considered in the evaluation and application of anorectal manometry.

회장낭-항문문합술 환자의 항문직장 내압검사 소견

유창식,김희철,박상규,김숙영,조영규,홍현기,김진천 대한대장항문학회 2001 Annals of Coloproctolgy Vol.17 No.4

골반저 근실조 환자의 직장항문내압검사에 따른 분류와 그 임상적 의의

정성희 ( Sung Hee Jung ),명승재 ( Seung Jae Myung ),양석균 ( Suk Kyun Yang ),정훈용 ( Hwoon Yong Jung ),김대현 ( Dae Hyun Kim ),김태훈 ( Tae Hun Kim ),장혜숙 ( Hye Sook Chang ),윤인자 ( In Ja Yoon ),권오련 ( Oh Ryoun Kwon ),홍원선 대한소화기학회 2003 대한소화기학회지 Vol.41 No.6

Background/Aims: The pathophysiology of pelvic floor dyssynergia (PFD) is unclear and heterogenous. The PFD patient could be classified according to several manometric patterns. However, its clinical significance is not known. The aims of this study were to classify PFD patients according to manometric patterns and to evaluate its clinical meaning including response to biofeedback therapy. Methods: Seventy patients (M:F 21:49, mean age 51±18) with PFD who fulfilled Rome criteria were examined with anorectal manometry. These patients were classified into 4 groups according to manometric patterns. The types were defined as follows: Type 1, adequate propulsive force with paradoxical anal contraction (n=49); type II, inadequate propulsive force with inappropriate anal contraction (n=3); type III, adequate propulsive force with failure to relax (n=13); type IV, inadequate propulsive force with failure to relax (n=5). We compared the clinical findings, parameters of manometry, and responses to biofeedback therapy of the 4 groups. Results: Clinical findings including subjective symptoms were not different among the 4 groups. On anorectal manometry, squeezing pressure was low in type II and type IV compared to type I and type III (p<0.05). Only forty patients underwent biofeedback therapy, and there was no difference in the biofeedback response rate among the 4 groups. Conclusions: Pelvic floor dyssynergia could be classified into four groups according to manometric patterns. However, the significance of this classification system is dubious because clinical features including responses to biofeedback therapy are not different among groups. (Korean J Gastroenterol 2003;41:456-464)

수술의 과거력이 없는 환자에서 항문직장 내압검사 후 발생한 직장 손상

정상수 ( Sang Su Jung ),명승재 ( Seung Jae Myung ),김이랑 ( Yi Rang Kim ),정훈용 ( Hwoon Yong Jung ),양석균 ( Suk Kyun Yang ),김진호 ( Jin Ho Kim ) 대한내과학회 2010 대한내과학회지 Vol.78 No.6

Colorectal injury related to anorectal manometry is very rare and is mostly associated with previous rectal surgery. We experienced two cases of colorectal injury related to anorectal manometry in patients without a history of surgery. The anorectal manometry finding of the first patient suggested rectal hyposensitivity, and the maximum tolerable volume was measured as 350 mL. After anorectal manometry, she complained of hematochezia. Sigmoidoscopy showed a deep 5 cm ulcer with vessel exposure at the rectum. She recovered after conservative treatment. In the second case, rectal bleeding occurred while measuring the maximal tolerable rectal volume. A 2.5 cm mural defect and 4 cm mucosal defect were detected in the rectosigmoid area at sigmoidoscopy. Computed tomography showed intraperitoneal free air around the distal sigmoid colon. She improved after conservative management. We suggest that anorectal manometry be performed with great caution, even in patients without a history of surgery. (Korean J Med 78:732-736, 2010)

난치성 변비의 진단적 접근법

이태희 대한내과학회 2017 대한내과학회지 Vol.92 No.6

난치성 변비 환자가 방문하였을 때 우선적으로 세밀한 병력 청취와 신체 검사를 통해 이차성 변비를 놓쳤을 가능성이없는지를 다시 한 번 확인하여야 한다. 전통적인 완하제 복용에도 효과가 없다면 프루칼로프라이드를 고려하고 반응이없다면 직장항문 기능 검사를 시행하여 변비의 병태생리를평가한다. 검사 결과에 따라 약물 혹은 바이오피드백 치료를시행하며 내과 치료에도 불구하고 반응이 없다면 수술을 고려하여야겠지만 상부위장관 운동기능 검사, 정신과적 평가 등을 통해 수술 환자를 선정하는 데 매우 신중을 기해야 한다.

직장감각저하 환자에서 바이오피드백 치료에 대한장기간 효과 및 인자 분석

정기욱 ( Kee Wook Jung ),명승재 ( Seung Jae Myung ),변정식 ( Jeong Sik Byeon ),윤인자 ( In Ja Yoon ),고정은 ( Jung Eun Ko ),서소영 ( So Young Seo ),윤순만 ( Soon Man Yoon ),도미영 ( Mi Young Do ),김도훈 ( Do Hoon Kim ),김병규 ( Be 대한장연구학회 2008 Intestinal Research Vol.6 No.1

Background/Aims: Rectal hyposensitivity (RH) has been treated with conventional biofeedback therapy (BFT), whereas the effectiveness and long term results of this therapy are not known. We aimed to investigate the effectiveness of BFT for patients with RH by conducting a retrospective review of prospectively collected data. Methods: From June 2004 to March 2007, we enrolled those RH patients who underwent BFT. BFT was performed two or three times every week. Six months after BFT, the clinical response was evaluated by subjective and objective parameters. Results: A total of 82 RH patients underwent BFT. Fifty three patients finished BFT and the other 29 patients dropped out during BFT. Thirty six patients (67.9%) showed responsiveness (R) to BFT and 17 (31.5%) showed non-responsiveness (NR). The characteristics between the two groups showed no difference, except for the “desire to defecate” volume (116.1±25.2 in the R group vs. 140.0±43.9 in the NR group, p value <0.05) and the rectoanal inhibitory reflex (RAIR) (15.6±0.5 in the R group R vs. 27.6±18.2 in the NR group, p value <0.05). The R group showed a shorter colon transit time compared to NR group. At six months after BFT, a total of 20 patients were interviewed; 15 patients answered that they still had responsiveness (75%). Conclusions: The patients with RH showed a similar BFT response to that of the constipated patients. However, the patients with a more hyposensitive rectum and a longer colonic transit showed NR to BFT, suggesting RH is an important factor in BFT responsiveness. (Intest Res 2008;6:56-69)