肛門構造およびセンサー運動機能の現代的な検査結果と便失禁の重症度との関係

The relationships between the results of contemporary tests of anorectal structure and sensorimotor function and the severity of fecal incontinence.

• Paul T Heitmann
• Philippa Rabbitt
• Ann C Schloithe
• David A Wattchow
• S Mark Scott
• Phil G Dinning

抄録

背景:

便失禁（FI）の診断検査では、肛門直腸の構造とセンサー運動機能を評価する。検査には、肛門マノメトリー、肛門感覚検査、下垂神経終末運動潜時（PNTML）、肛門内超音波検査などがあります。FIの重症度と検査結果はしばしば不一致があり、治療後の症状の改善率は40％未満である。この研究では、最近の検査結果とFI重症度との関連性の強さを評価することを目的としています。

BACKGROUND: Diagnostic investigations for fecal incontinence (FI) assess the structure and sensorimotor function of the anorectum. Investigations include anorectal manometry, anorectal sensory testing, pudendal nerve terminal motor latencies (PNTML), and endoanal sonography. The severity of FI and results of investigations are often discordant and the rate of symptom resolution following treatment remains <40%. High-resolution anorectal manometry (HRAM) and three-dimensional endoanal ultrasound (3D-US) have been introduced during the last decade. This study aims to assess the strength of relationships between contemporary investigation results and FI severity.

方法:

FIの調査のために来院した成人は、St Mark's FI重症度スコア（SMIS）、HRAM、肛門感覚検査、PNTML、および3D-USを使用して評価されました。

METHODS: Adults presenting for investigation of FI were assessed using the St Mark's FI severity score (SMIS), HRAM, anorectal sensory testing, PNTML, and 3D-US.

主要な結果:

SMISとHRAM（安静時圧r = -0.23、95％CI = (-0.34, -0.11), P<.001；スクイズ圧（r = -0.26、95％CI = (-0.37, -0.14), P<.001）および3D-US（前部EAS長r = -0.22、95％CI = (-0.34, -0.09), P<.001）との間に有意な関係があった。SMISとHRAMの関係は、衝動優位の症状を有する者ではより大きな効果の大きさを有していた（安静時圧：r = -0.40、95％CI = (-0.57, -0.20), P < .001, スクイズ圧：r = -0.40, 95％CI = (-0.57, -0.20), P < .001）。全体的に、肛門検査で占められたSMISの分散は8.6％（R = 0.098、調整後R = 0.086、P < 0.001）であった。

KEY RESULTS: 246 patients were included. There were significant relationships between the SMIS and HRAM (resting pressure r = -0.23, 95% CI = (-0.34, -0.11), P < .001; squeeze pressure (r = -0.26, 95% CI = (-0.37, -0.14), P < .001) and 3D-US (anterior EAS length r = -0.22, 95% CI = (-0.34, -0.09), P = .001). The relationships between SMIS and HRAM had a greater effect size in those with urge-predominant symptoms (resting pressure: r = -0.40, 95% CI = (-0.57, -0.20), P < .001, squeeze pressure: r = -0.34, 95% CI = (-0.52, -0.12), P = .003). Overall, the variance in SMIS accounted for by anorectal investigations was 8.6% (R = 0.098, adjusted R = 0.086, P < .001).

結論と関連性:

肛門直腸検査はFI重症度の強力な予測因子ではない。これらの所見は、FIの多因子、異質な病態生理、SMISと肛門検査の限界、および肛門外因性因子を反映している可能性がある。

CONCLUSIONS AND INFERENCES: Anorectal investigations are not strong predictors of FI severity. These findings may reflect the multifactorial, heterogeneous pathophysiology of FI, the limitations of the SMIS and anorectal investigations, and contributing factors extrinsic to the anorectum.

© 2020 John Wiley & Sons Ltd.