摘要:目的: 隨機對照研究、評估生物反饋訓練治療慢性功能性便秘的療效。 方法 : 60例慢性功能性便秘患者,隨機分為治療組30例和對照組30例。治療組接受1個療程(5周)生物反饋訓練治療(10次為一個療程、一次30～45分鐘、每周2次)。對照組患者接受聚乙二醇4000 10g BID 口服,療程5周。治療前后作便秘癥狀評分、結腸通過試驗檢測、直腸肛門壓力檢測。 結果 : 生物反饋訓練和聚乙二醇4000均可使多數慢性功能性便秘患者的大便次數、大便性狀及伴隨癥狀恢復正常或緩解,總有效率分別為667%和80%(P ＞005)。生物反饋訓練和聚乙二醇4000口服治療后,結腸通過試驗72小時標志物排出率分別為75%及73%,均較治療前明顯增加。生物反饋訓練治療后力排時肛門壓明顯下降。 結論 : 生物反饋訓練對出口梗阻型、慢傳輸型便秘均有效,是一種有效的、新興的治療慢性功能性便秘的方法,可作為功能性便秘的一線治療方法。Abstract: Objective: To assess the clinic effect of biofeedback therapy for functional constipation. Methods : Sixty cases of chronic functional constipation were randomly divided into treatment group (30 cases) and control group (30 cases). Cases in the treatment group were exposed to biofeedback for a fiveweeklong treatment course—individual treatment lasted for 3045 minutes and twice per week. Patients in the control group received PEG 4000 10g BID for five weeks. Data from constipation symptom score, colonic transit test, and anorectal manometry were done and compared before and after two kinds of treatments. Results : Biofeedback training and PEG 4000 could restore the stoolfrequency, stool characteristics and accompanying symptoms to normal or mitigation of the majority of patients with chronic functional constipation, with the total effective rates being 667% and 80% (P gt;005), respectively. After biofeedback training and PGE 4000 treatment, the discharge rate of 72hour markers of colonic transit test significantly increased to 75% and 73%, respectively. Additionally, anorectal pressure decreased dramatically after biofeedback training. Conclusion : Biofeedback training would play a positive role in outlet obstruction and slow transit constipation. Thus, it could be an effective firstline treatment of chronic functional constipation.
Objective To assess the efficacy and safety of Chinese herbal medicines for chronic functional constipation. Methods We searched CNKI (1989 to November, 2009), CBM (1989 to November, 2009), VIP (1989 to November, 2009), Cochrane Library (Issue 4, 2009), PubMed (1966 to November, 2009) and EMbase (1986 to November, 2009). All randomized and quasi-randomized clinical trials of treating chronic functional constipation with Chinese herbal medicines versus untreated, placebo or western drug groups were included. Data were extracted independently by two reviewers. The methodological quality of trials was evaluated with Cochrane Handbook 5.0.2 criteria. Meta-analyses were conducted by the RevMan 5.0 software. Results Twenty-one trials involving 2 602 patients were included. The Meta-analysis results showed that: Chinese herbal medicines improved both syndromes and colonic transit function of recipients; moreover, it is superior to both gastrointestinal prokinetic agent in effective rate (RR=1.18, 95%CI 1.12 to 1.25), healing rate (RR=1.59, 95%CI 1.35 to 1.88), and cathartic in effective rate (RR=1.18, 95%CI 1.10 to 1.27), healing rate (RR=1.16, 95%CI 1.29 to 2.10). Integration of Chinese herbal medicines and gastrointestinal prokinetic agent is superior to gastrointestinal prokinetic agent in effective rate (RR=1.21 95%CI 1.09 to 1.34) and healing rate (RR=1.41, 95%CI 1.11 to 1.79). Conclusion Some Chinese herbal medicines may be effective and safe in treating chronic functional constipation, which can not be bly proved at present for lack of studies with high quality.
ObjectiveTo investigate changes in anal dynamics and anorectal sensory function in patients with irritable bowel syndrome with constipation (IBS-C) and detect its status of basin’s myoelectric pressure. MethodsThirty-six patients with IBS-C (IBS-C group) and 28 healthy volunteers (control group) were collected. The rectal-anal canal pressure and the change of the basin’s myoelectric status were detected by the ZJ-D3 gastrointestinal motility tester and bio-stimulus feedback instrument, respectively. The anal canal resting pressure, rectal resting pressure, anorectal pressure difference, length of anal canal high pressure area, rectal sensation threshold, rectal compliance, and basin’s myoelectric voltage were compared between these two groups. ResultsThere were no significant differences in the rectal resting pressure and anal canal resting pressure between the IBS-C group and the control group (t=–2.312, P=0.851; t=–5.464, P=0.283), but the difference value of anorectal pressure of the IBS-C group was significantly higher than that of the control group (t=4.371, P=0.017), and the length of the anal canal hypertension area in the IBS-C group was significantly longer than that of the control group (t=6.180, P=0.042). The maximal and minimum basin’s myoelectric voltage and frequency of the basin’s myoelectric voltage in the IBS-C group were significantly higher than those in the control group (t=3.386, P=0.031; t=5.763, P=0.042; t=8.410, P<0.001). ConclusionAnorectal dynamics and rectal sensory dysfunction are one of important causes of IBS-C, it might be existed abnormal changes in basin’s myoelectric voltage.
1概述便秘是很常見的癥狀，在美國便秘的發生率為2%，英國為10%，日本為4%，我國天津為4.4%［1］，女性發病概率是男性的3倍。多數便秘患者可經藥物治療治愈或改善癥狀，少數為難治性。少數便秘患者經手術治療效果較好。便秘不是一種病，而是多種疾病的一個癥狀，不同的患者有不同的含義，包括： ①大便量少、硬，排出困難； ②排便困難合并一些特殊的癥候群，如長期用力排便、直腸脹感、排便不完全或依靠手法幫助排便； ③7天內排便次數少于2～3次。臨床上常診斷為慢性頑固性便秘或特發性便秘，但其確切含義很難描述。“慢性”意指病史至少2年，或年幼時就發病； “特發性”說明我們對便秘的原因及流行病學了解不全面； “頑固性”意指經一般藥物及非手術治療很難奏效，常需手術治療［2］。
Objective To explore the medium- and long-term clinical effects of procedure for prolapse and hemorrhoids (PPH) combined with Block operation for obstructed defecation syndrome (ODS). Methods Clinical data of 187 patients with ODS caused by rectocele (RE) who received PPH+Block operation or pure PPH operation in The Chaoyang City Central Hospital from Mar. 2011 to May. 2013, were collected retrospectively, in which 95 patients underwent PPH+Block operation (PPH+Block group) and 92 patients underwent PPH operation (PPH group). Compared the postoperative Longo’s score, postoperative clinical effect, operative effect, and recurrence rate between the 2 groups. Results ① The postoperative Longo’s score: the postoperative Longo’s scores of the PPH+Block group were both lower than those of the PPH group at 1- and 3-year after operation (P<0.05). ② Postoperative curative effect: the total effective rate of the PPH+Block group and the PPH group were both 100%, but the clinical effect of the the PPH+Block group was better than that of the PPH group (Z=–10.15, P<0.05). ③ Operative effect: there was no statistical significance on operative time, intraoperative blood loss, returned to normal activity time, hospital stay, and postoperative visual analogy score (VAS) between the 2 groups (P>0.05). In addition, there were no statistical significance on the incidences of urinary retention, hematochezia, exhaust anal incontinence, and anal fissure between the 2 groups (P>0.05), but the incidence of urgent or high anal straining feeling in the PPH+Block group was significantly higher than that of the PPH group (P<0.05). ④ Medium- and long-term recurrence rate: the recurrence rate of 1-year after operation was similar between these2 groups (P>0.05), but the recurrence rate of 3-year after operation in the PPH+Block group was significantly lower than that of the PPH group (P<0.05). Conclusions The medium clinical effect has no obvious difference between PPH+Block and PPH operation, but the long-term recurrence rate of the former is lower than that of the latter, and the medium- and long-term effect is stable in PPH+Block operation for ODS caused by RE.
ObjectiveTo investigate efficacy of total colectomy-ileorectal anastomosis (IRA) and subtotal colectomy-ileosigmoidal anastomosis (ISA) in treatment of patients with slow transit constipation (STC).MethodsThe clinical data of 45 patients with STC underwent operation from January 2008 to January 2015 were analyzed retrospectively. These patients were divided into an IRA group and ISA group according to the operation method, there were 23 cases in the IRA group and 22 cases in the ISA group. The operative time, intraoperative blood loss, postoperative hospitalization, use of antidiarrheal drugs, and complications rate in both groups were compared. All the patients were followed up at the 3th, 6th, 12th, and 24th month after the operation, the defecation frequency, Wexner continence score, Wexner anal incontinence score, gastrointestinal quality of life index score, abdominal pain frequency score, and abdominal distension frequency score in two groups were evaluated.ResultsThere were no significantly statistical differences between the two groups in the operation time, intraoperative blood loss, and postoperative complications rate (P>0.05). In the perioperative period, compared with the IRA group, the ISA group had a shorter postoperative hospitalization and a relatively lower proportion of antidiarrheal drugs, the differences were statistically significant between the two groups (P<0.05). On the postoperative 3th, 6th, and 12th month, the frequency of defecation in the IRA group was significantly higher than that in the ISA group (P<0.05). The Wexner continence score, Wexner anal incontinence score, gastrointestinal quality of life index score, abdominal pain frequency score, and abdominal distension frequency score had no statistical differences between the two groups (P>0.05).ConclusionsISA and IRA are safe and effective in treatment of STC, it might be selected according to patient’s conditions. On premise of strictly grasping indications, ISA has more obvious advantages.