대한대장항문학회

Purpose : Current study was designed to assess the functional etiology of patients<br>with pelvic outlet obstruction. Moreover, physiologic characteristics and theirs clinical<br>significances were evaluated in the patients with ramified diagnosis. Methods : 172<br>patients with pelvic outlet obstruction were performed 328 numbers of physiologic<br>studies. These included cinedefecography (n=172), anal manometry (n=87), colonic transit<br>time study (n=38), and anal EMG/PNTML (n=31). On the basis of physiologic findings,<br>patient groups were categorized as rectocele (group I), nonrelaxing puborectalis<br>syndrome (group II), anal dyschezia (group III), and rectoanal intussusception (group<br>IV). The physiologic findings were compared between subgroup patients. Results :<br>Incidence of categorized patients was 51.7% (group I, n=89), 22.7% (group II, n=39),<br>12.2% (group III, n=21), and 8.7% (group IV, n=15), respectively. The mean age of<br>patients with group III were lower (p＜0.05) than that of overall patients. The incidence<br>of female patients was higher in group I and the incidence of male patients was higher<br>in group II (p＜0.0001). In cinedefecography, patients with group II showed smaller<br>anorectal angle at strain (p＜0.001), at dynamic change between rest and strain<br>(p=0.002). In anal manometry, patients with group III showed higher mean resting<br>pressures (p=0.001), higher maximum resting pressures (p＜0.001), higher mean squeeze<br>pressures, and higher maximal voluntary contraction (p=0.003) than those of patients<br>with other group. In neurologic study, mean value of PNTML was 2.32 0.34 (range,<br>1.60∼3.66) msec in overall patients. The size of rectocele was increased in proportion to<br>patient's age (r=0.229, p＜0.05), number of delivery (r=0.393, p=0.001), and degree of<br>perineal descent (r=0.231, p＜0.05). The degree of perineal descent was increased in<br>proportion to patient's age (r=0.249, p＜0.05). Conclusions : Present series provided the<br>diagnostic ramification of pelvic outlet obstruction by using the anorectal physiologic<br>investigations. In addition to the function of puborectalis muscle, evacuation dynamics of<br>anorectum should be emphasized. These findings could provide the fundamental<br>information for guideline of future therapy in the patients with obstructed defecation.<br>