慢性便秘临床特点及相关因素调查177例

目的:分析慢性便秘的临床特点和影响其加重程度的因素,为进一步诊疗提供参考依据.方法:采用整群分层方法筛选符合罗马Ⅲ标准的慢性便秘患者,对符合纳入标准的177例进行问卷调查,调查内容包括一般情况和疾病相关因素等共132个项目,调查结果经双人录入、核对后,进行统计学分析.结果:慢性便秘患者中,男女在患病年龄上有显著性差异(P=0.04).慢性便秘症状谱广泛,在不用药情况下,最常见症状为排便费力(68.9%).在患者性别上存在统计学差异的症状仅为用手抠便(x2=7.937,P=0.005).排便次数减少(<3次/周)、反酸、上腹烧灼感、上腹饱胀、上腹疼痛和体质量减轻与慢性便秘的严重程度关系密切(P<0.05).男性饮酒、女性妊娠次数和分娩次数与慢性便秘严重程度有密切关系(P<0.05).结论:通过改变生活方式、养成排便习惯(至少每周>3次),预防伴随症状和警报症状,培养就诊意识,可预防和减少慢性便秘向重度发展.     

The accuracy of assessment of walking distance in the elective spinal outpatients setting

Self reported walking distance is a clinically relevant measure of function. The aim of this study was to define patient accuracy and understand factors that might influence perceived walking distance in an elective spinal outpatients setting. A prospective cohort study. 103 patients were asked to perform one test of distance estimation and 2 tests of functional distance perception using pre-measured landmarks. Standard spine specific outcomes included the patient reported claudication distance, Oswestry disability index (ODI), Low Back Outcome Score (LBOS), visual analogue score (VAS) for leg and back, and other measures. There are over-estimators and under-estimators. Overall, the accuracy to within 9.14 metres (m) (10 yards) was poor at only 5% for distance estimation and 40% for the two tests of functional distance perception. Distance: Actual distance 111 m; mean response 245 m (95% CI 176.3–314.7), Functional test 1 actual distance 29.2 m; mean response 71.7 m (95% CI 53.6–88.9) Functional test 2 actual distance 19.6 m; mean response 47.4 m (95% CI 35.02–59.95). Surprisingly patients over 60 years of age (n = 43) are twice as accurate with each test performed compared to those under 60 (n = 60) (average 70% overestimation compared to 140%; p = 0.06). Patients in social class I (n = 18) were more accurate than those in classes II–V (n = 85): There was a positive correlation between poor accuracy and increasing MZD (Pearson’s correlation coefficient 0.250; p = 0.012). ODI, LBOS and other parameters measured showed no correlation. Subjective distance perception and estimation is poor in this population. Patients over 60 and those with a professional background are more accurate but still poor.     

肠舒饮治疗习惯性便秘临床观察

为观察肠舒饮治疗习惯性便秘的临床疗效,将72例习惯性便秘（气血亏虚型）患者随机分为两组,治疗组38例采用肠舒饮治疗;对照组34例,予车前番泻颗粒治疗,观察两组用药后情况。结果显示,治疗组和对照组治疗两个疗程后的总有效率分别为92．11％和91．18％（P〉0．05）,不良反应发生率分别为13．16％和35．29％（P〈0．05）。结果表明,肠舒饮治疗习惯性便秘疗效确切,且不良反应少,值得临床推广。     

经会阴补片修补加耻骨直肠肌部分离断术治疗出口梗阻型便秘34例

为探讨经会阴补片修补加耻骨直肠肌部分离断术治疗出口梗阻型便秘的临床效果,对34例重度直肠前突伴耻骨直肠肌肥厚的出口梗阻型便秘患者行经会阴补片植入修补直肠前突加经肛周耻骨直肠肌部分离断术,并对疗效进行跟踪随访。结果显示,痊愈30例,显效3例,无效1例,总有效率为97．1％（33／34）。结果表明,经会阴补片修补加耻骨直肠肌部分离断术治疗出口梗阻型便秘操作简便,效果满意。     

Repeat Retrourethral Transobturator Sling in the Management of Recurrent Postprostatectomy Stress Urinary Incontinence After Failed First Male Sling

Background

A failure rate between 20% and 45.5% after retrourethral transobturator sling (RTS) is reported. Recommendations for the management of persistent or recurrent postprostatectomy stress urinary incontinence (SUI) after failed male sling do not exist.

Objective

The aim of this study was the prospective evaluation of the efficacy of repeat RTS (RRTS) in patients after failed first RTS.

Design, setting, and participants

Between March 2007 and August 2009, 35 patients with mild to severe SUI after failed first RTS were treated with a second AdVance sling (American Medical Systems, Minnetonka, MN, USA).

Measurements

Preoperative and postoperative evaluation included daily pad use, 1-hr pad test, postvoiding residual (PVR) urine, uroflowmetry, and quality-of-life (QoL) scores.

Results and limitations

After 6 mo, 45.5% (15 of 33 patients) showed no pad use; 30.3% (10 of 33 patients), one dry “security” pad; 3% (1 of 33 patients), one wet pad; 6.1% (2 of 33 patients), two pads; 3% (1 of 33 patients), pad reduction ≥50%; and 12.1% (4 of 33 patients), treatment failure. After 16.6 mo, 34.5% (10 of 29 patients) showed no pad use; 37.9% (11 of 29 patients), one dry “security” pad; 3.4% (1 of 29 patients), one wet pad; 3.4% (1 of 29 patients), two pads; 10.3% (3 of 29 patients), pad reduction ≥50%; and 10.4% (3 of 29 patients), treatment failure. Daily pad use and pad weight decreased significantly. PVR and uroflowmetry results showed no significant change. QoL improved significantly. Postoperative acute urinary retention was observed in 23.6% of patients.

Conclusions

RRTS is an effective and safe treatment option for the management of SUI after failed first RTS.     

A Critical Analysis of Orthotopic Bladder Substitutes in Adult Patients with Bladder Cancer: Is There a Perfect Solution?

Context

Orthotopic bladder substitute (OBS) has been popularized over the past 2 decades as a diversion following radical cystectomy for invasive bladder cancer. Various reports, mostly single-center experiences, are published on patients with OBS.

Objective

This study reviews the literature regarding indications, postoperative care, complications, quality-of-life measures, as well as functional and oncologic outcomes that have been published on patients with OBS.

Evidence acquisition

An English-language literature review of the Medline database (1990 to January 2010) of published data on patients with OBS following radical cystectomy for bladder cancer was undertaken. Articles that included surgery for noncancer etiology were excluded.

Evidence synthesis

Indications and patient selection criteria have significantly widened over the past 2 decades. Comparable oncologic data have been reported between patients with OBS versus other diversions. Secondary urethral tumors seem less common in patients with OBS compared with those with conduits or continent cutaneous diversions. Durable daytime and nocturnal continence is achieved in 85–90% and 60–80%, respectively. Continence is inferior in elderly patients with OBS. Urinary retention remains significant in the female patients, ranging from 25% to 50%. Complications including electrolyte disturbances, altered sensorium and drug metabolism, mucus retention, rupture, urinary tract infections, and upper tract deterioration are reviewed.

Conclusions

Indications for OBS following radical cystectomy in patients with invasive bladder cancer have significantly widened over the past 2 decades. An OBS should be offered to both male and female patients in the absence of contraindications. Good long-term functional and oncologic outcomes can be achieved in patients with OBS treated in high-volume institutions by experienced surgeons with specific knowledge in the field. Preoperative patient information, patient selection, surgical techniques, and careful postoperative follow-up are the cornerstones to achieve good long-term results.     

功能性消化不良与社会心理因素的相关性

功能性消化不良发病率居高不下,症状顽固,许多患者都伴有不同程度的焦虑抑郁情绪,严重影响了患者的生活和工作,本文就其最新的一些研究内容做一综述。     

阴道后壁“桥式”修补结合盆底筋膜缝合治疗阴道后壁缺陷临床分析

目的探讨阴道后壁＂桥式＂修补结合盆底筋膜缝合治疗阴道后壁缺陷的临床疗效。方法回顾性分析我院行阴道后壁＂桥式＂修补结合盆底筋膜缝合术患者83例,比较手术前后盆腔器官脱垂定量（POP-Q）分度的变化,以了解术后患者的盆底解剖学恢复情况,通过观察患者排便情况评价患者手术前后排便功能失调的改善情况,通过盆腔器官脱垂-尿失禁患者性生活调查问卷（PISQ-12）评价患者手术前后的性生活质量。结果单纯行＂桥式＂缝合的平均手术时间15 min,无手术并发症。术后1例后壁膨出复发,复发率为1.2%,术后排便症状改善率为81.2%,性交痛的发生率为2.63%,PISQ-12评分术前（79.57&#177;6.56）分,术后（78.62&#177;6.40）分,手术前后比较差异无显著性。结论阴道后壁＂桥式＂修补近期疗效确切,能改善部分患者的便秘症状,对患者性生活质量也无明显影响。     

不同分型功能性消化不良患者病理生理机制的比较研究

目的 比较不同分型功能性消化不良(FD)患者是否具有不同的病理生理机制.方法 评价80例FD患者[罗马Ⅲ标准,男∶女为22∶58,平均(44.2±14.6)岁]消化不良症状的严重程度和分型,并行多种胃肠功能检查.结果 上腹痛综合征(EPS)、餐后不适综合征(PDS)和混合型三组间在胃排空功能、胃肌电活性、自主神经功能、液体负荷试验同步胃内压测定以及心理评定方面的差异均无统计学意义(P值均＞0.05).餐后饱胀感与胃半排空时间呈正相关(偏相关系数为11.5,P=0.043).早饱与最大饮入量呈负相关(偏相关系数为-6.8,P=0.033).结论 本研究发现罗马Ⅲ分型方法 可能并不能有效地将有不同病理生理机制的FD患者区分开,从而采取有针对性的治疗.     

生物反馈训练对功能性便秘患者临床症状、心理状况和生活质量的影响

Objective To explore the effects of biofeedback training on clinical symptom,psychological state and quality of life in patients with functional constipation (FC).Methods Forty-nine patients with FC diagnosed by Rome Ⅲ were enrolled and received biofeedback training Bowel symptom measure, Zung's self-rating anxiety scale (SAS), self-rating depression scale (SDS) and Chinese version of the MOS 36-item short form healthy survey (SF-36) were recorded to assess the effects before and aftertreatment.Results After biofeedback training, clinical symptom of patients with FC was greatly improved:there was a very significant decrease in total and subscales scores of bowel symptom including spontaneous frequency of bowel movements, straining effort, sensation of anorectal obstruction/blockage, stool consistence and bloating.Patients with FC also improved their quality of life as well as psychological status after biofeedback.All subcategories of SF-36 including general health, physical function, bodily pain, role physical, vitality, social function, role emotion and mental health showed marked increase.Compared to the scores before biofeedback training, SAS (41.0 ±8.1 vs 46.5 ± 11.9) and SDS (44.0 ±8.2 vs 51.2 ±11.5) scores decreased significantly after biofeedback training Conclusion Biofeedback training can improve clinical symptom, psychological status and quality of life in patients with FC.