변실금에서 음부신경전도검사의 진단적 가치와 항문압 검사와의 관계
Diagnostic Value of Pudendal Nerve Conduction Study and Relationship with Anal Manometry in Fecal Incontinence
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Objective: To evaluate the diagnostic value of pudendal nerve terminal motor latency (PNTML) and the relationship with manometric profiles in patients with fecal incontinence. Method: A total of 29 patients with fecal incontinence who visited colorectal clinic were recruited. The PNTMLs of 29 patients were compared with those of normal controls (2.03±0.39) using one-sample t test. Patients were classified into three groups according to pudendal nerve latency; Group I (normal latency, n=8), group II (unilaterally delayed latency, n=9), group III (bilaterally delayed latency, n=12) and compared with manometric parameters (mean maximal resting pressure, mean maximal squeezing pressure, 1st sense volume, urge sense volume, maximal tolerance volume). Results: The PNTML is 3.83±2.19 in right side, 4.57±2.19 in left side which are significantly delayed in patients with fecal incontinence compare to that of normal controls, 2.03± 0.39. (p=0.031 in Rt., p=0.000 in Lt.) Among group I∼III, there were no statistically significant differences in the values of mean maximal resting pressure, mean maximal squeezing pressure, 1st sense volume, urge sense volume and maximal tolerance volume. There was no correlation between the PNTML and any of manometric parameters. Conclusion: The PNTML is valuable in diagnosing patients with fecal incontinence. It is suggested that combined assessments are necessary to identify the cause of fecal incontinence.
Abstract
Objective: To evaluate the diagnostic value of pudendal nerve terminal motor latency (PNTML) and the relationship with manometric profiles in patients with fecal incontinence. Method: A total of 29 patients with fecal incontinence who visited colorectal clinic were recruited. The PNTMLs of 29 patients were compared with those of normal controls (2.03±0.39) using one-sample t test. Patients were classified into three groups according to pudendal nerve latency; Group I (normal latency, n=8), group II (unilaterally delayed latency, n=9), group III (bilaterally delayed latency, n=12) and compared with manometric parameters (mean maximal resting pressure, mean maximal squeezing pressure, 1st sense volume, urge sense volume, maximal tolerance volume). Results: The PNTML is 3.83±2.19 in right side, 4.57±2.19 in left side which are significantly delayed in patients with fecal incontinence compare to that of normal controls, 2.03± 0.39. (p=0.031 in Rt., p=0.000 in Lt.) Among group I∼III, there were no statistically significant differences in the values of mean maximal resting pressure, mean maximal squeezing pressure, 1st sense volume, urge sense volume and maximal tolerance volume. There was no correlation between the PNTML and any of manometric parameters. Conclusion: The PNTML is valuable in diagnosing patients with fecal incontinence. It is suggested that combined assessments are necessary to identify the cause of fecal incontinence.
참고문헌 (24)
- Chung SS, "Functional investigation with use of anorectal physiology in the patients with fecal incontinence", J Korean Surg Soc, 57, pp.996~1007 (1999)
- Mimura T, "Diagnostic evaluation of patients with feacal incontinence at a specialist institution", Dig Surg, 21, pp.235~241 (2004)
- Nelson R, "Community-based prevalence of anal incontinence", JAMA, 274, pp.559~561 (1995)
- Madoff RD, "Faecal incontinence in adults", Lancet, 364, pp.621~632 (2004)
- Cheong DM, "Electrodiagnostic evaluation of fecal incontinence", Muscle Nerve, 18, pp.612~619 (1995)
- Thomas C, "Respective value of pudendal nerve terminal motor latency and anal sphincter electromyography in neurogenic fecal incontinence", Neurophysiol Clin, 32, pp.85~90 (2002)
- Ricciardi R, "The utility of pudendal nerve terminal motor latencies in idiopathic incontinence", Dis Colon Rectum, 49, pp.852~857 (2006)
- Suilleabhain CB, "The relationship of pudendal nerve terminal motor latency to squeeze pressure in patients with idiopathic fecal incontinence", Dis Colon Rectum, 44, pp.666~671 (2001)
- Gooneratne ML, "Unilateral pudendal neuropathy is common in patients with fecal incontinence", Dis Colon Rectum, 50, pp.449~458 (2007)
- Kamm MA, "Obstetric damage and faecal incontinence", Lancet, 344, pp.730~733 (1994)
- Salvioli B, "Pemberton JH, Phillips SF. Rectal compliance, capacity, and rectaoanal sensation in fecal incontinence", Am J Gastroeneterol, 96, pp.2158~2168 (2001)
- Rao SS, "Minimum standards of anorectal manometry", Neurogastroenterol Motil, 14, pp.553~559 (2002)
- Kiff ES, "Slowed conduction in the pudendal nerves in idiopathic (neurogenic) fecal incontinence", Br J Surg, 71, pp.614~616 (1984)
- Na YM, "Pudendal nerve conduction study by use of St. Mark’s pudendal electrode", J Korean Acad Rehab Med, 19, pp.398~401 (1995)
- Kim KH, "Anal manometric assessment of patients with anal disease and defecation disorders", J Korean Surg Soc, 55, pp.549~555 (1998)
- Kouraklis G, "Evaluating patients with anorectal incontinence", Surg Today, 34, pp.304~312 (2004)
- Sangwan YP, "Unilateral pudendal neuropathy. Significance and implications", Dis Colon Rectum, 39, pp.249~251 (1996)
- Pradal-Prat D, "Pudendal nerve motor latency correlation by age and sex", Elctromyogr Clin Neurophysiol, 38, pp.491~496 (1998)
- Joo JS, "Clinical significance of amplitude in pudendal nerve conduction study in patients with defecation disorders", J Korean Soc Coloproctol, 14, pp.241~246 (1998)
- Scott SM, "Manometric, sensorimotor, and neurophysiologic evaluation of anorectal function", Gastroenterol Clin North Am, 37, pp.511~538 (2008)
- Duthie HL, "The relation of sensation in the anal canal to the functional anal sphincter; a possible factor in anal continence", Gut, 4, pp.179~ (1963)
- Park HJ, "The evaluation of anorectal sensory function in patients with chronic constipation and fecal incontinence", J Korean Soc Coloproctol, 12, pp.321~326 (1996)
- Gilliland R, "Pudendal neuropathy is predictive of failure following anterior overlapping sphincteroplasty", Dis Colon Rectum, 41, pp.1516~1522 (1998)
- Hannaway CD, "Fecal incontinence", Obstet Gynecol Clin North Am, 35, pp.249~269 (2008)