Abstract
Specialized tests of anorectal function are designed to complement but not to replace good clinical examination and sound professional judgement. The different methods of recording pressure changes have advantages and disadvantages. Poor correlation exists when data recorded using miniature balloons are compared with data from microtransducers. Prolonged ambulatory monitoring of anal sphincter and rectal pressure reveal that spontaneous transient episodes of sphincter relaxation are demonstrable in normal subjects. In the investigation of patients with possible traction injury to the pudendal nerve, electromyography and pudendal nerve terminal motor latency data are more precise than manometry data. Good correlation between noninvasive surface electromyography using an intraanal plug electrode and anal manometry can be attained. Mapping of sphincter defects using concentric needle technology is reasonably accurate but distinctly painful. Dynamic defecography readily demonstrates abnormalities of the rectal wall. The division between what is normal and what is clinically relevant is rather imprecise. Comparative studies of sonographic and electromyographic mapping of sphincter defects give good correlation. Recent application of fine hooked electrodes have demonstrated periodic episodes of smooth muscle and sphincter relaxation. The saline infusion test and balloon expulsion test help to accurately quantify the difficulty patients experience in retention or evacuation, respectively. Perineometry is a simple, rapid, noninvasive method of measuring the extent of perineal descent on straining. Although reproducible, it tends to underestimate the degree of descent when compared with the radiological method but it avoids the use of ionized radiation.
Résumé
Les examens pointus, explorant la fonction anorectale, sont conçus pour compléter, et non point remplacer un examen clinique bien fait ainsi qu'un bon jugement professionnel. Les différentes méthodes de prise de pression ont chacune leurs avantages et leurs inconvénients. Cependant, la corrélation entre enregistrements par ballonnets miniatures et microtransducteurs n'est pas bonne. Le monitorage ambulatoire prolongé de la pression des sphincters anal et rectal montre qu'il existe des épisodes transitoires de relaxation sphinctérienne, bien visibles chez le sujet normal. Lorsqu'une lésion par traction du nerf honteux est soupçonnée, l'électromyographie et l'enregistrement de la latence motrice distale sont plus précis que la manométrie. Il existe une bonne corrélation entre l'électromyographie non-invasive au moyen d'une électrode “bouchon” intra-anale et la manométrie. La mise en évidence de défects sphinctériens en utilisant la technique d'aiguilles concentriques est précise, certes, mais, très pénible pour le patient. La défécographie dynamique détecte facilement les anomalies de la paroi rectale. La limite, cependant, entre ce qui est normal et ce qui est cliniquement parlant, est imprécise. Les résultats des études comparant les anomalies par l'échographie et l'électromyographie sont comparables. L'application récente d'électrodes fines crochues a démontré des épisodes périodiques de relaxation du muscle lisse et du sphincter. Le test de l'infusion de sérum physiologique et l'expulsion du ballon aident á quantifier la difficulté que les patients ont à retenir les matières ou à exonérer. Enfin, le périnéométrie est une méthode simple, rapide, et noninvasive pour mésurer le degré de descente périnéale lors de l'effort d'exonération. Bien qu'il soit répetable, cet examen tend à sous-estimer le degré de ptose comparé aux méthodes radiologiques, mais il a l'avantage de ne pas nécessiter l'utilisation des rayons.
Resumen
Las pruebas especializadas de la función anorrectal han sido diseñadas como complemento y no como sustituto de un buen examen clínico ni de un sano juicio profesional. Cada uno de los diversos métodos para el registro de presiones posee sus propias ventajas y desventajas. Existe pobre correlación entre los datos que proveen los estudios con balones miniatura y la información derivada de la utilización de microtransductores. La monitoría ambulatoria prolongada de las presiones del esfínter anal y del recto revela que en individuos normales se presentan episodios transitorios de relajación del esfínter. En el estudio de pacientes con una posible lesión de tracción del nervio pudendo, aparece evidente que la electromiografía del nervio pudendo y los estudios de latencia motora terminal son de mayor precisión que la información manométrica. Se observa buena correlación entre la electromiografía de superficie, método no invasivo que utiliza un electrodo intraanal, y la monometría anal. El “mapeo” de los defectos del esfínter por medio de la tecnología de punciones concéntricas aparece razonablemente certero, pero es indudablemente doloroso. La defecografía dinámica demuestra bien las anormalidades de la pared rectal, pero la línea divisoria entre lo que es normal y lo que es clínicamente pertinente es bastante imprecisa. Los estudios comparativos entre el “mapeo” sonográfico y el “mapeo” electromiográfico de los defectos del esfínter demuestran una buena correlación. Recientement se ha hecho énfasis sobre la investigación del esfínter interno. La actividad electromiográfica del músculo liso puede ser registrada por medio de electrodos finos de gancho. Tales registros demuestran episodios periódicos de relajación del músculo liso y del esfínter. Las pruebas de infusión de solución salina y de expulsión de balón son útiles, respectivamente, para cuantificar la dificultad que algunos pacientes experimentan en cuanto a retención o a evacuación. La perineometría es un método simple, rápido y no invasivo de medición del grado de descenso o de pujo perineal. Aunque respetable, tiende a subestimar el grado de descenso en comparación con el método radiológico, pero tiene la ventaja de evitar la irradiación.
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Parks, T.G. The usefulness of tests in anorectal disease. World J. Surg. 16, 804–810 (1992). https://doi.org/10.1007/BF02066974
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DOI: https://doi.org/10.1007/BF02066974