耻骨直肠肌综合征

通过对一个社区和二个村坊１８０００人的人群调查，发现有各类慢性便秘者３７７人，其中耻骨直肠肌综合征者３１人。通过各种方法治疗并随访３年，试图分析其诊断指标及各阶段的治疗方案。     

耻骨直肠肌综合征诊治进展

耻骨直肠肌综合征(puborectalis syndr-ome,PRS)是顽固性便秘的常见原因之一。其名称较多,如:肛门痉挛、痉挛性盆底综合征、反常性耻骨直肠肌收缩及耻骨直肠肌肥厚     

耻骨直肠肌部分松解术治疗耻骨直肠肌综合征62例

为探讨耻骨直肠肌部分松解术治疗耻骨直肠肌综合征所致便秘的临床疗效,对62例经症状、体征及相关检查确诊为耻骨直肠肌综合征所致便秘患者采用耻骨直肠肌部分松解术治疗,观察治疗后临床疗效及随访3个月疗效。结果显示,62例患者治疗后总有效率为96．7％,随访3个月疗效为95．2％。结果表明,耻骨直肠肌部分松解术治疗耻骨直肠肌综合征所致便秘安全有效。     

耻骨直肠肌综合征的诊断与治疗

耻骨直肠肌综合征(puborectalis syndrome,PRS)是顽固性便秘的常见原因之一。过去其名称混乱,如:盆底痉挛综合征、反常性耻骨直肠肌收缩、耻骨直肠肌肥厚及耻骨直肠肌综合征等。随着研究的不断深入,对该病的认识日趋完善,“耻骨直肠肌综合征”     

耻骨直肠肌综合征

病例介绍　　患者,×××,男,４８岁,因反复便秘二年,加重伴腹胀四天,于１９９６年２月２９日入院。患者于４年前因患胃癌,在地方医院行胃癌根治术。术后恢复良好,食欲及二便正常。近两年来,出现便秘,常服泻药才能排便。入院前四天,腹胀且进行性加重,并停止排气排便,但无呕吐。查体：一般情况较差,消瘦,意识清楚,心肺无异常。全腹膨隆,压痛,肠鸣音亢进,可闻及气过水声。Ｘ线腹透可见腹腔内有大量气液平,考虑为急性肠梗阻,在连续硬膜麻醉下,行剖腹探查术。术中见小肠明显扩张,肠腔内有大量气体,液体,腹腔内未见任何…     

闭孔内肌移植术治疗耻骨直肠肌综合征的体会

方法：对２６例耻骨直肠肌综合征病人采用耻骨直肠肌后方切断术，同时再游离并切断闭孔内肌坐骨附着端断端与侧方耻骨联合肌及部分括约肌缝合。结果：２６例病人均有一定程度症状缓解，大便１￣２次／ｄ，随访６个月至３年，无１例复发。讨论：把游离的闭孔内肌与侧方耻骨直肠肌作缝合，可拮抗耻骨直肠肌的反常收缩，防止术后再粘连。结论：该方法对治疗耻骨直肠肌痉挛引起的便秘有满意的疗效。     

经直肠耻骨直肌部分切断、纵切横缝术治疗耻骨直肠肌综合征的临床疗效评价

目的:探讨耻骨直肠肌综合征的外科治疗.方法:将36例耻骨直肠肌综合征患者随机分为两组,治疗组(18例)采用经直肠耻直肌部分切断、纵切横缝术;对照组(18例)采用后位耻直肌部分切断术.对两组患者的术后疗效、愈合时间、术后并发症等进行观察分析.结果:治疗组与对照组在术后并发症,愈合时间等方面比较有统计学意义.结论:经直肠耻直肌部分切断、纵切横缝术治疗耻骨直肠肌综合征疗效确切,术后并发症少.     

Detrusor inhibition on selective pudendal nerve stimulation in the perineum

Selective electrical pudendal nerve stimulation calibrated to achieve a “maximal motor response” as recorded electromyographically in the periurethral sphincter was found to increase the micturition threshold in three neurological patients with detrusor hyperreflexia. Such electrical stimulation (0.2-ms long pulses at 5 Hz and up to 2.0 mA) could conceivably be also supplied by an implanted “vesicoinhibitory” stimulator, and this report is considered as a pilot study towards formulation of such a therapeutic approach.     

Influence of pudendal nerve blockade on stress relaxation in the female urethra

The urethral pressure decay following a sudden and sustained dilatation corresponds to stress relaxation. Urethral stress relaxation can be described by the equation P_t = P_equ + P_αe^-t/τα + P_βe^-t/τβ, where P_t is the pressure at time t, P_equ is the equilibrium pressure after dilatation, P_α and P_β are pressure decay, and τ_α and τ_β are time constants. The time constants have previously proved independent of the way the dilatation is performed. The urethral stress relaxation obtained in 10 healthy women before and after pudendal nerve blockade was analysed by the mathematical model and the pressure parameters and time constants determined. The fast time constant, τ_β, was reduced by the nerve blockade, whereas τ_α was unaffected, however, both P_α and P_β were reduced. No single stress relaxation parameter can therefore be related to the muscle or the connective tissue components. The method may prove useful in the further evaluation of the closure function of the urethra with special reference to the pathophysiology of stress urinary incontinence. © 1996 Wiley-Liss, Inc.     

A new minimally invasive technique for pudendal nerve stimulation1

Aim Pudendal nerve stimulation (PNS), which is an alternative to sacral nerve stimulation, requires neurophysiological confirmation of correct siting of the electrode. We describe a modification of the existing technique where placement is assisted by guidance to the ischial spine by a finger introduced per anum. Method Cadaveric dissection was carried out to confirm the accuracy of this new approach. The surface marking of the ischial spine is marked. A stimulating needle electrode inserted through a skin incision at this point, is advanced towards the ischial spine using a finger introduced per anum as a guide. Once effective stimulation of the pudendal nerve is confirmed by observed and palpated contraction of the anal musculature, a permanent stimulating electrode is inserted and the position confirmed by radiological screening. Results Using cadaveric studies, the correct surface markings for needle placement were confirmed. This technique was then applied successfully for in vivo insertion of the needle electrode in 20 patients with bowel dysfunction, with only one lead displacement occurring over a mean follow‐up period of 12 months. Conclusion Finger‐guided assistance of PNS electrode insertion is simple and reproducible without requiring neurophysiological confirmation of nerve stimulation to ensure correct lead location.     

Diagnostic criteria for pudendal neuralgia by pudendal nerve entrapment (Nantes criteria)

AIMS: The diagnosis of pudendal neuralgia by pudendal nerve entrapment syndrome is essentially clinical. There are no pathognomonic criteria, but various clinical features can be suggestive of the diagnosis. We defined criteria that can help to the diagnosis. MATERIALS AND METHODS: A working party has validated a set of simple diagnostic criteria (Nantes criteria). RESULTS: The five essentials diagnostic criteria are: (1) Pain in the anatomical territory of the pudendal nerve. (2) Worsened by sitting. (3) The patient is not woken at night by the pain. (4) No objective sensory loss on clinical examination. (5) Positive anesthetic pudendal nerve block. Other clinical criteria can provide additional arguments in favor of the diagnosis of pudendal neuralgia. Exclusion criteria are also proposed: purely coccygeal, gluteal, or hypogastric pain, exclusively paroxysmal pain, exclusive pruritus, presence of imaging abnormalities able to explain the symptoms. CONCLUSION: The diagnosis of pudendal neuralgia by pudendal nerve entrapment syndrome is essentially clinical. There are no specific clinical signs or complementary test results of this disease. However, a combination of criteria can be suggestive of the diagnosis.     

Early structural effects of oestrogen on pudendal nerve regeneration in the rat

OBJECTIVE: To determine the early effects of oestrogen on the ultrastructure of the pudendal nerve and distal nerve fascicles near the external urethra sphincter (EUS) after a pudendal nerve crush injury. The pudendal nerve is one of the pelvic floor tissues injured during vaginal delivery, possibly contributing to the development of stress urinary incontinence (SUI) in women, the symptoms of which often do not appear until menopause, implicating hormonal factors. MATERIALS AND METHODS: Twenty-seven virgin female Sprague-Dawley rats were anaesthetized and underwent ovariectomy. Three days later, they had one of four procedures: bilateral pudendal nerve crush plus implant of a subcutaneous oestrogen-containing capsule (NC+E); nerve crush plus implant of a sham saline-containing capsule (NC+S); no nerve crush with an oestrogen capsule; or no nerve crush with a sham capsule. After 2 weeks the pudendal nerves and urethral tissues were prepared for light and electron microscopy. The number of axons, myelin figures and endoneurial nuclei in the pudendal nerve segment distal to the lesion were counted. Nerve fascicles near the EUS were also counted and categorized as normal or showing signs of degeneration and/or regeneration. The location of each nerve fascicle was specified as either ventral or dorsal. RESULTS: As there were no significant differences between the two control groups they were combined to form a single control group. In the distal pudendal nerve there were significantly fewer myelinated axons and large myelinated axons in the NC+E and NC+S groups than in the control group. There were three times as many large unmyelinated axons in the NC+E group than in either the NC+S or control groups (P < 0.05). There were only half as many nerve fascicles near the ventral side of the EUS in the NC+S group than in both the control and NC+E groups (P < 0.05). CONCLUSION: Oestrogen appears to affect large unmyelinated axons in both the injured pudendal nerve and at the denervated EUS target. After pudendal nerve crush, nerve fascicles with evidence of degeneration or regeneration near the EUS appear to be spared with oestrogen treatment, particularly in the ventral region. These observations may reflect the early stages of a neuroregenerative effect of oestrogen. Additional studies are needed to confirm these results at later periods and with functional methods.