出口梗阻型便秘影像学诊断及临床治疗研究进展

出口梗阻型便秘是临床上发生率较高的功能性肛肠疾病,属于功能性便秘中常见病、多发病,患者常伴有肛门、盆底结构与功能异常。出口梗阻型便秘根据其病理特点可分为盆底松弛综合征与盆底痉挛综合征两类,但是无论何种类型均伴有排便困难、无便意及排便不尽感等。目前,出口梗阻型便秘的临床诊断方法多以直肠管测压、结肠传输功能试验、超声、肛门直肠指检及排粪造影等为主,均能帮助患者早期确诊。内科治疗、手术治疗等均为出口梗阻型便秘常用的治疗方法,不同方法各有优缺点,多数患者可从中获益。手术治疗虽然能改善出口梗阻型便秘患者症状,但经腹部游离直肠到盆底时并发症发生率相对较高,且患者术后复发率亦相对较高,影响患者预后。因此,本文对出口梗阻型便秘的类型、影像学诊断及临床治疗等研究进展进行综述,以期为出口梗阻型便秘的临床诊疗提供帮助。     

洁肠水疗仪对出口梗阻型便秘的疗效观察

目的评价洁肠水疗仪对出口梗阻型便秘的治疗效果。方法选择69例出口梗阻型便秘患者,实验组35,对照组34例。实验组采用洁肠水洗治疗,对照组用开塞露和果导片,两组疗程均为2周。结果实验组总有效率为74.29%,对照组总有效率为47.05%。结论洁肠水疗仪对于出口梗阻型便秘的疗效确切。     

功能性出口梗阻型便秘患者肛管直肠功能与血胃动素的相关性研究

目的 研究血胃动素及肛管直肠功能改变在功能性出口梗阻型便秘发病中的作用，探讨胃动素及其受体激动剂可否用于治疗出口梗阻型便秘。方法 根据结肠运输时间和运输指数选择出口梗阻型便秘患者，设健康对照组，行肛管直肠测压检查，测定血胃动素并分析其与肛管直肠测压指标值的相关性。结果 出口梗阻型便秘患者的肛管静息压升高，模拟排便时直肠肛管压差显著降低，引起直肠肛管抑制反射的最小松弛容积及直肠感觉阈值均高于健康人。患者血胃动素无明显变化，胃动素水平与肛管静息压、最大缩榨压及模拟排便时肛管压力成正相关，与模拟排便时直肠肛管压差成负相关。结论 出口梗阻型便秘发病基础是肛门括约肌舒张失调，排便时直肠肛管不协调，直肠敏感性低；血胃动素正常便秘惠者可能有更多出口梗阻问题，出口梗阻型便秘患者不宜采用胃动素或其受体激动剂治疗。     

生物反馈治疗出口梗阻型便秘的疗效及其机理探讨

目的 探讨生物反馈治疗出口梗阻型便秘的临床疗效及机理.方法 对我院2012年1月至2012年12月收治的87例出口梗阻型便秘患者进行生物反馈治疗,观察治疗后患者肛管静息压、直肠感知阈值、排便阈值及最大耐受量情况,并与治疗前比较,评价其临床疗效.结果 治疗结束后痊愈44例,显效20例,有效13例,无效10例,总有效率为88.51％;治疗后患者的肛管静息压、直肠感知阈值、排便阈值及最大耐受量均有明显下降,与治疗前比较差异显著(P ＜0.01).结论 生物反馈治疗出口梗阻性便秘疗效满意,值得临床推广应用.     

洁肠水疗仪治疗便秘的疗效观察

目的评价新型洁肠水疗仪治疗出口梗阻型便秘的效果及安全性。方法选择78例出口梗阻型便秘患者,观察组41人,对照组37人。观察组采用新型洁肠水疗仪治疗,对照组采用旧型洁肠水疗仪治疗,两组疗程均为两周。结果观察组总有效率为90．24％,对照组总有效率为70．27％。结论Idear2IBI-01C新型洁肠水疗仪对于出口梗阻型便秘的疗效确切、安全。     

结肠运输试验与排粪造影检查对临床便秘的诊断价值

目的探讨结肠运输试验和排粪造影检查对便秘的诊断价值。方法对86例便秘患者做结肠运输试验及排粪造影检查。结果结肠运输异常者59例,出口梗阻者72例,两者均存在者45例。结论由于结肠运输异常和出口梗阻常合并存在且相互作用,所以结肠运输试验与排粪造影检查联合应用,能够更加准确的鉴别功能性梗阻与结肠运输所致的便秘,为临床治疗提供可靠依据。     

排便障碍

随着对胃肠功能性疾病研究的逐渐深入以及人们对生活质量要求的不断提高 ,临床上功能性便秘的患者明显增加。功能性便秘可分为慢通过型、出口梗阻型及混合型。排便障碍主要是指由于盆底肌协调障碍 (ｐｅｌｖｉｃｆｌｏｏｒｄｙｓｓｙｎｅｒｇｉａ)或大便困难(ｄｙｓｃｈｅｚｉａ)引起的排出粪便的障碍 ,这一类又可以称为出口梗阻型便秘 (ｏｕｔｌｅｔｏｂｓｔｒｕｃｔｉｖｅｃｏｎｓｔｉｐａ ｔｉｏｎ,ＯＯＣ)常由于盆底肌、肛门括约肌在排便时的活动不能协调或感觉异常所致。1　流行病学根据北京协和医院对北京地区 2 486名 1 8～ 70岁常住…     

经肛双吻合器直肠切除吻合术手术(STARR)治疗出口阻塞型便秘的临床疗效

目的探讨经肛双吻合器直肠切除吻合术手术(STARR)治疗出口阻塞型便秘的临床疗效。方法选择该院2010年1月—2011年1月收治的42例出口阻塞型便秘患者为研究对象,所有患者均接受STARR手术进行治疗,分析回顾患者的临床疗效。结果所有患者经过临床治疗,其临床症状均显著改善,生存质量显著改善,临床治疗效果较为理想。讨论本次实验结果表明,经肛双吻合器直肠切除吻合术手术治疗出口阻塞型便秘,具有较为满意的临床治疗效果,因而临床推广价值较高。     

中西医结合治疗慢传输型便秘

便秘是由多种疾病的病理过程引起的一种复杂性症状，与性别、年龄、饮食、职业、遗传、文化程度、家庭收入、地理分布、居住区域以及种族、性格等多种因素有关。根据国内外文献报道，便秘的发病率为2％～3％，国内外的学者均报道便秘的发病率是女性高于男性，女性是男性的2～3倍。便秘的原因各异，现代医学将便秘分为慢传输型便秘、出口梗阻型便秘和混合型便秘3种，其中，慢传输型便秘占慢性便秘者的10％～40％。本文谈谈慢传输型便秘的治疗。     

肛门直肠指诊662例临床分析

目的通过对662例肛门直肠指诊患者的临床资料分析,探讨直肠指诊在肛门直肠疾病诊断中的价值,从而认识直肠指诊的重要性。方法 662例门诊患者接受了直肠指诊,比较直肠指诊的结果。结果直肠指诊检出阳性病种前五位分别是:痔、出口梗阻型便秘、前列腺炎及前列腺增生、直肠息肉及直肠癌。直肠肛门疾病的发病与年龄和性别有一定关系。便秘是消化道最常见症状之一,而且和多种肛门直肠疾病有一定关系。便血是结肠癌最常见症状。结论直肠指诊在肛门直肠疾病诊断中有重要作用。     

TURP联合雄激素阻断治疗晚期前列腺癌伴膀胱出口梗阻疗效观察

目的探讨经尿道前列腺电切（TURP）联合雄激素阻断治疗晚期前列腺癌伴膀胱出口梗阻的临床疗效。方法回顾性分析23例应用TURP联合雄激素阻断治疗晚期前列腺癌伴出口梗阻患者的临床资料,观察患者住院时间、手术时间、留置尿管时间,及手术前后前列腺体积、生活质量评分（QOL）、国际前列腺症状评分（IPSS）、前列腺特异性抗原（PSA）、最大尿流速度（Qmax）、残余尿量（RU）的变化。结果 23例患者手术均成功,1例术后输血400 ml,无前列腺电切综合征现象,住院天数（9.0±3.2）d,手术时间45～120 min,术后留置导尿管时间5～7 d。术前前列腺体积、QOL、IPSS、PSA、Qmax、RU分别为（87.53±18.46）cm3、（3.54±1.16）分、（18.96±3.83）分、（76.32±20.47）μg/L、（9.08±2.76）ml/s、（142.53±34.66）ml,术后1个月前列腺体积（46.52±13.43）cm3、QOL（2.15±1.30）分、IPSS（12.78±3.34）分、PSA（1.82±0.63）μg/L、Qmax（19.20±3.98）ml/s、RU（29.86±16.33）ml,手术前后上述指标比较,差异均有统计学意义（均P〈0.01）,术后第3个月PSA（0.66±0.21）μg/L（P〈0.01）。结论 TURP联合雄激素阻断治疗晚期前列腺癌伴膀胱出口梗阻安全、有效,近期疗效确切,能明显缓解患者尿路梗阻症状,提高患者生活质量,但远期疗效有待进一步研究。     

巨大黏膜下子宫肌瘤合并感染坏死及排尿困难一例

黏膜下子宫肌瘤主要临床表现为月经异常、白带增多,巨大黏膜下子宫肌瘤可因重力脱出宫颈外口而伴有感染、坏死,也可出现便秘、尿频尿急、排尿困难等压迫症状,治疗以开腹手术为主。现报道1例巨大黏膜下子宫肌瘤伴有感染、坏死、重度贫血及排尿困难病例,就其诊治过程,尤其是术前准备进行分析讨论,以期提高临床医生对此病的认识并提供参考。     

Cows’ Milk Allergy-Associated Constipation: When to Look for It? A Narrative Review

Constipation is a very common disorder, mostly functional in nature, that may persist for years in up to 35–52% of children. Food allergy prevalence, severity and persistence are increasing over time, and cows’ milk protein is the commonest food allergen recognised to affect gastrointestinal motility in children. There is mounting evidence of the role of cows’ milk (CM) allergy (CMA) in children with constipation. With this narrative review, we aim to provide clinicians with an updated and critical overview of food allergy-associated constipation. We searched Embase, Medline and the Cochrane Library, using keywords related to the topic. Only reviews and studies including children aged 0–17 years that were published in English were considered. Constipation has been reported in 4.6% of infants with CMA; the prevalence of food allergy underlying chronic constipation in children resistant to conventional treatment and presenting to tertiary clinics ranges between 28% and 78%. The identification of predisposing risk factors and of a specific phenotype of food allergy-induced constipation remains elusive. No allergic tests, radiological or motility investigations achieve sufficient sensitivity and specificity to screen children for CMA-related constipation. A 4-week cows’ milk protein (CMP) elimination diet may be considered for children with chronic constipation resistant to conventional treatment and who lack alarm sign/symptoms of organic diseases. In subjects with ameliorated symptoms on CMP elimination, the diagnosis of CMA should be confirmed by a food challenge to avoid an unnecessary protracted diet.     

Rare Occurrence of Mix Stromal Tumours: A Case Report of Gastrointestinal and Extra-Intestinal Stromal Tumour on the Jejunum and Omentum of a Nine Year Old Girl from Adamawa State,Nigeria

Background

Stromal tumors of the jejunum (GIST) and omentum (EGIST) are uncommon and dearth of information still exists on their occurrence concurrently.

Case Details

Here, we report a nine year old girl that presented with tender abdominal mass measuring 14 × 8 cm associated with features of gastric outlet obstruction and hyponatremia of 115mmol/L. A diagnosis of hyponatremia in a child with gastric outlet obstruction secondary to intraabdominal mass was made for which exploratory laparotomy was carried out. Histology of the tumour revealed stromal spindle epithelioid as well as myxoid cells. Complete resection of the tumour and correction for hyponatremia was done in addition to antibiotics therapy with remarkable improvement.

Conclusion

Index case is that of mixed stromal tumours that presented with features of gastric outlet obstruction, and the patient did well after surgery.     

结肠癌并肠梗阻术中处理探讨（附34例病例）

目的：探讨结肠癌并肠梗阻的术中处理方法和效果。方法回顾分析我科2010年7月-2013年12月收治的34例合并有肠梗阻的结肠癌患者的病历资料,并进行总结。结果34例患者经过适当手术处理治疗后,除了1例术后出现伤口感染,3例高龄患者术后伤口哆开,其余患者术后未出现并发症,痊愈出院。结论应选择合适的术式及术中处理方法对结肠癌并发肠梗阻患者进行治疗,这样能够显著地减少并发症的发病率,显著提高治疗效果。     

Chronic constipation in childhood. A report of 78 patients

AIM: To assess the aetiology and the clinical patterns of chronic constipation in children. METHODS: A total of 78 patients (62% boys, mean age: 4.6 years) were enrolled in this retrospective study. For each patient, we collected these data: clinical features, radiological data, rectal manometry and rectal biopsy results, treatment and follow up. RESULTS: Functional constipation was the most frequent cause of chronic constipation (49 cases, 62.8%) followed by Hirschsprung's disease (19 cases, 24.3%). Rectal manometry, performed in all suspected Hirschsprung's disease, concluded to the absence of inhibitory rectoanal reflex in 17 of them. Rectal biopsy concluded to segmental absence of parasympathetic ganglion cells in eleven of them. Therapeutic approach consists of treatment of functional constipation by laxatives, enemas and dietary fibers in respectively 22, 12 and 6 children. Two other patients had a biofeedback re-education. Treatment was successful in 9 patients and unsuccessful in 2 others. Seven children with Hirschsprung's disease underwent Soave's (n = 3), Swenson's (n = 3) and Duhamel's procedures (n = 1). Outcome was favourable in five of them and complicated by stenosis in 2 others. CONCLUSION: Our study suggests that functional constipation is the most frequent cause of chronic constipation in children and that Hirschsprung's disease is the first organic cause of chronic constipation indicating the need of rectal manometry for diagnostic confirmation.     

Outlet syndrome: is there a surgical option?

Of 46 patients investigated for constipation, 21 were found to have some other primary abnormality, leaving 25 patients for study: 6 had evidence of the outlet syndrome alone, 5 had slow transit constipation, 8 had both abnormalities and 6 had no apparent physiological disorder in the colon or rectum. Although colectomy and ileorectal anastomosis gave good results for slow transit constipation, partial pelvic floor division provided satisfactory long-term improvement in only one of the 7 patients with the outlet syndrome.