慢性功能性便秘肛门直肠敏感性和排便动力学研究

目的探讨慢性功能性便秘患者肛门直肠感觉功能的改变及排便时肛门直肠动力学特征。方法采用PC Polygraf HR高分辨多道胃肠功能测定仪检测46例功能性便秘患者的肛门直肠压力、直肠容量感知、疼痛阈值、耐受阈值及排便功能等指标，并与16例健康人做对照。结果功能性便秘组直肠静息压、肛管括约肌静息压、最大缩窄压及静态肛管长度与对照组比较差异无显著性，但功能性便秘患者的初始感觉阈值、疼痛阈值、排便阈值、引起肛门直肠抑制反射的最低充气量、排便状态下肛管功能长度和肛管内括约肌松弛压均高于对照组。模拟排便时，功能性便秘组34．78％的患者在直肠收缩时伴有肛管括约肌的矛盾收缩。结论功能性便秘患者直肠黏膜对容量刺激的反应性降低和排便时肛管括约肌的反向矛盾收缩可能是形成便秘的原因之一。     

电针八髎穴对不协调型功能性排便障碍患者的肛管直肠动力学影响

[目的]探讨电针八髎穴对不协调型功能性排便障碍患者肛管直肠动力学的影响。[方法]选取66例符合诊断的不协调型功能性排便障碍患者为研究对象,随机分为2个组,电针组(33例)采用电针八髎穴治疗;反馈组(33例)采用生物反馈治疗。2组均在4个疗程后,观察患者的肛管直肠动力学情况及克利夫兰便秘评分(CCCS)、ODS评分及便秘生活治疗量表(PAC-QOL)评分。[结果]治疗后,电针组与反馈组比较,CCCS评分、ODS评分及PAC-QOL评分差异有统计学意义。治疗后电针组肛管静息压、直肠静息压、最大收缩压、肛管高压区长度、初始感觉阈值、最大容量感觉阈值各项数据明显改善,优于反馈组,均差异有统计学意义(P<0.01)。[结论]电针八髎穴治疗对不协调型功能性排便障碍患者临床疗效显著,可有效提高患者的生存质量,其机制可能与改善患者肛管直肠动力学相关,远期疗效有待进一步研究。     

直肠前膨出与功能性排便障碍：肛门直肠压力与感觉功能检测

背景：直肠前膨出（RC）是一种多见于女性的肛肠疾病,与功能性排便障碍（FDD）的关系目前尚不明。目的：研究伴RC的FDD患者肛门直肠压力和感觉功能的变化,探讨RC与FDD的关系。方法：选取28例伴RC的FDD患者并分为伴轻度RC的FDD组和伴中-重度RC的FDD组,设不伴RC的FDD患者作为对照。所有患者行球囊排出试验、肛门直肠压力和感觉功能检测,并按照罗马Ⅲ标准将FDD患者进一步分为排便协同失调（F3a）和排便推进不足（F3b）两种亚型。结果：除伴中-重度RC的FDD组直肠排便收缩压显著低于不伴RC的FDD组外（P〈0.05）,其余各组间直肠静息压、肛管静息压、肛管最大缩榨压、直肠排便收缩压、肛门括约肌松弛率以及初始感觉容量、产生便意容量和最大耐受容量均无明显差异。与不伴RC的FDD组相比,伴RC的FDD组中F3b亚型比例显著升高（P〈0.05）。结论：伴中-重度RC的FDD患者直肠排便收缩压明显降低,伴RC的FDD患者多表现为F3b亚型,提示RC与FDD的发病可能具有相关性。     

排便障碍的功能性便秘患者精神心理因素的研究

[目的]分析排便障碍的功能性便秘(FC)患者的精神心理因素特点。[方法]纳入符合罗马Ⅳ标准、有排便障碍的FC患者146例,以及25例健康对照者。所有入选者接受采用Zung的焦虑自评量表(self-rating anxiety scale,SAS)和抑郁自评量表(self-rating depressive scale,SDS)测试,评估其精神心理状况。分析排便障碍的FC患者精神心理因素的特点。[结果]FC组的SAS、SDS评分均明显高于健康对照组(P0.05),女性患者的SAS评分及SDS评分均高于男性患者(P0.05)。60岁与≥60岁患者的SAS、SDS比较差异无统计学意义(P0.05)。I、Ⅱ、Ⅳ型排便障碍的女性患者SAS评分高于男性(P0.05),Ⅱ、Ⅲ型排便障碍的女性患者SDS评分高于男性(P0.05)。[结论]排便障碍的FC患者具有较高的焦虑抑郁倾向,女性患者比男性患者更容易产生焦虑、抑郁情绪。     

功能性便秘患者肛管、直肠动力学变化及西沙必利影响的研究

我们对５０例功能性便秘患者进行了肛管、直肠动力学的测定并观察服用西沙必利前后肛管、直肠动力学的变化,旨在探讨便秘与肛直肠动力学的关系,观察药物的疗效,为临床治疗提供理论根据。材料与方法一、对象患者年龄平均４６岁（２４～６９岁）,共５０例,男１８例,女...     

成人功能性排便障碍的生物反馈、聚乙二醇4000治疗

目的 评价生物反馈、聚乙二醇4000综合治疗成人功能性排便障碍(FDD)的疗效.方法 64例FDD患者分成3组,分别接受生物反馈(BF)(n=20)、聚乙二醇4000(PEG 4000)(n=23)及两者联合治疗(n=21),治疗后1周内及3个月时比较3组病例的临床疗效.结果 治疗后1周内3组病例总有效率比较差异无显著性(P>0.05),显效率差异有显著性(P<0.05),其中PEG 4000组和综合治疗组均明显高于BF组(P<0.05);治疗后3个月时总有效率和显效率差异均有统计学意义(P<0.05),其中BF组和综合治疗组的总有效率及显效率均明显高于PEG 4000组(P<0.05).结论 BF联合PEG 4000治疗成人FD具有良好的短、中期疗效,是一种有效的治疗方法.     

功能性便秘患者直肠肛门压力变化

目的研究功能性便秘患者直肠肛门运动功能,探讨该疾病发生的可能机制。方法测定了35例慢性功能性便秘患者和11例正常对照者的直肠肛门压力及排便功能。结果①直肠静息压、肛门括约肌静息压及其最大缩窄压等在功能性便秘患者和正常人之间无显著差异(P>0.05);②肛管高压带长度在功能性便秘患者显著高于正常人(P<0.0005);③功能性便秘患者直肠壶腹部的感觉阈值和最大耐受量显著高于正常对照组(P<0.05),直肠最大顺应性显著低于正常对照组(P<0.0005),引起直肠肛门抑制反射的直肠扩张容量在便秘组显著高于正常对照组(P<0.05),肛门松弛率在便秘组显著低于正常对照组(P<0.05);④功能性便秘患者排便时肛门内外括约肌松弛反射均障碍,尤以外括约肌明显。结论功能性便秘患者存在直肠肛门运动功能障碍,这在其发病机制中起重要作用。     

生物反馈治疗对不同亚型功能性排便障碍患者临床疗效的影响

目的:探讨生物反馈治疗对不同亚型功能性排便障碍患者临床疗效的影响。方法:收集120例功能性排便障碍患者,其中不协调性排便(F3a)和排便推进不足(F3b)2个亚型各60例。每个亚型再随机将患者分为常规组和生物反馈组,各30例。常规组采用聚乙二醇4000散剂治疗4周,生物反馈组采用短期生物反馈强化治疗方案治疗4周,比较各组患者临床症状、焦虑自评量表(SAS)、抑郁自评量表(SDS)、中文版患者便秘状况评估问卷(PAC-QOL)评分、肛门直肠动力、感觉变化。结果:治疗后,F3a型生物反馈组和F3a型常规组,F3b型生物反馈组和F3b型常规组比较,临床症状积分、SAS分值、SDS分值、PAC-QOL评分、直肠最低敏感量、最大耐受量、直肠顺应性、肛门括约肌压力均较低(均P<0.05),直肠静息压的差异无统计学意义(均P>0.05),而F3a型生物反馈组与F3b型生物反馈组比较,各项指标的差异均无统计学意义(均P>0.05)。此外,F3a型和F3b型生物反馈组治疗后分别与治疗前比较,常规组治疗后分别与治疗前比较,临床症状积分、SAS分值、SDS分值、PAC-QOL评分、直肠最低...     

功能性排便障碍患者合并焦虑、抑郁和躯体症状的调查

目的了解功能性排便障碍患者合并焦虑、抑郁及躯体症状阳性率及其危险因素分析。 方法选择2020年11月~2021年9月期间就诊于西京消化病院便秘专科门诊的功能性排便障碍患者86例,根据GAD-7、PHQ-9和PHQ-15量表计分,统计患者合并焦虑、抑郁及躯体症状的发生率,并采用Logistics回归分析其危险因素。 结果入组患者86例,男性18例（20.9%）,女性68例（79.1%）,平均年龄（46.7±13.4）岁,中位病程7.5（3~15.3）年。焦虑的发生率80.2%,抑郁的发生率73.2%,躯体症状的发生率94.2%。单因素回归分析可见排便费力（χ²=10.489,P＜0.05）和排便不尽感（χ²=9.389,P＜0.05）与患者合并躯体症状相关。多因素回归分析显示排便不尽感是患者合并焦虑（OR=4.831,95%CI：1.364~17.117,P＜0.05）、抑郁（OR=4.214,95%CI：1.162~15.282,P＜0.05）和躯体症状（OR=7.809,95%CI：1.058~57.617,P＜0.05）的独立危险因素。 结论功能性排便障碍患者极易伴发焦虑、抑郁及躯体症状且患者具有排便不尽症状是合并焦虑、抑郁及躯体症状的独立危险因素。     

Effects of Caffeine on Anorectal Manometric Findings

Purpose  This study was designed to evaluate the effects of caffeine on anorectal function by anorectal manometry. Methods  Ten healthy subjects were studied. They drank 200 ml of water and later 200 ml of a solution that contained caffeine 3.5 mg/kg body weight. The anorectal manometric study was divided into three periods: basal, water, and caffeine; each period lasted 45 minutes. Results  After the ingestion of water, the basal anal sphincter pressure showed no change during the 45-minute recording, whereas after caffeine consumption the basal anal sphincter pressure increased at 10 minutes (P = 0.047) and 15 minutes (P = 0.037). The average basal anal sphincter pressure throughout the 45 minutes was significantly higher after caffeine ingestion than after water (P = 0.013). After caffeine intake, the maximum squeeze pressure increased significantly (P = 0.017) compared with the basal period. Both water and caffeine consumption caused a decrease in the rectal sensory threshold for the desire to defecate. Conclusions  Caffeine 3.5 mg/kg body weight in 200 ml of water resulted in stronger anal sphincter contractions both at basal period and during voluntary squeeze. The sensory threshold was also decreased, leading to an earlier desire to defecate. Caffeine consumption may result in an earlier desire to defecate, leading to defecation if the anal sphincter can relax voluntarily.     

Anorectal functional outcome after repeated transanal endoscopic microsurgery

AIM:To evaluate the status of anorectal function after repeated transanal endoscopic microsurgery(TEM).METHODS:Twenty-one patients undergoing subtotal colectomy with ileorectal anastomosis were included.There were more than 5 large( 1 cm) polyps in the remaining rectum(range:6-20 cm from the anal edge).All patients,19 with villous adenomas and 2 with low-grade adenocarcinomas,underwent TEM with submucosal endoscopic excision at least twice between 2005 and 2011.Anorectal manometry and a questionnaire about incontinence were carried out at week 1 before operation,and at weeks 2 and 3 and 6 mo after the last operation.Anal resting pressure,maximum squeeze pressure,maximum tolerable volume(MTV) and rectoanal inhibitory reflexes(RAIR) were recorded.The integrity and thickness of the internal anal sphincter(IAS) and external anal sphincter(EAS) were also evaluated by endoanal ultrasonography.We determined the physical and mental health status with SF-36 score to assess the effect of multiple TEM on patient quality of life(QoL).RESULTS:All patients answered the questionnaire.Apart from negative RAIR in 4 patients,all of the anorectal manometric values in the 21 patients were normal before operation.Mean anal resting pressure decreased from 38 ± 5 mmHg to 19 ± 3 mmHg(38 ± 5 mmHg vs 19 ± 3 mmHg,P = 0.000) and MTV from 165 ± 19 mL to 60 ± 11 mL(165 ± 19 mL vs 60 ± 11 mL,P = 0.000) at month 3 after surgery.Anal resting pressure and MTV were 37 ± 5 mmHg(38 ± 5 mmHg vs 37 ± 5 mmHg,P = 0.057) and 159 ± 19 mL(165 ± 19 mL vs 159 ± 19 mL,P = 0.071),respectively,at month 6 after TEM.Maximal squeeze pressure decreased from 171 ± 19 mmHg to 62 ± 12 mmHg(171 ± 19 mmHg vs 62 ± 12 mmHg,P = 0.000) at week 2 after operation,and returned to normal values by postoperative month 3(171 ± 19 vs 166 ± 18,P = 0.051).RAIR were absent in 4 patients preoperatively and in 12(2 = 4.947,P = 0.026) patients at month 3 after surgery.RAIR was absent only in 5 patients at postoperative month 6(2 = 0.141,P = 0.707).Endosonography demonstrated that IAS disruption occurred in 8 patients,and 6 patients had temporary incontinence to flatus that was normalized by postoperative month 3.IAS thickness decreased from 1.9 ± 0.6 mm preoperatively to 1.3 ± 0.4 mm(1.9 ± 0.6 mm vs 1.3 ± 0.4 mm,P = 0.000) at postoperative month 3 and increased to 1.8 ± 0.5 mm(1.9 ± 0.6 mm vs 1.8 ± 0.5 mm,P = 0.239) at postoperative month 6.EAS thickness decreased from 3.7 ± 0.6 mm preoperatively to 3.5 ± 0.3 mm(3.7 ± 0.6 mm vs 3.5 ± 0.3 mm,P = 0.510) at month 3 and then increased to 3.6 ± 0.4 mm(3.7 ± 0.6 mm vs 3.6 ± 0.4 mm,P = 0.123) at month 6 after operation.Most patients had frequent stools per day and relatively high Wexner scores in a short time period.While actual fecal incontinence was exceptional,episodes of soiling were reported by 3 patients.With regard to the QoL,the physical and mental health status scores(SF-36) were 56.1 and 46.2(50 in the general population),respectively.CONCLUSION:The anorectal function after repeated TEM is preserved.Multiple TEM procedures are useful for resection of multi-polyps in the remaining rectum.     

Biofeedback therapy for dyssynergic defecation

INTRODUCTION Chronic constipation is a common self-reported bowel symptom that affects 2%-30% of people in Western countries and has considerable impact on health expenses and quality of life[1]. Most patients respond either to fiber- fluid supplementatio…     

Anorectal abnormalities in progressive systemic sclerosis

Seventeen patients with progressive systemic sclerosis (PSS) were evaluated with manometry for anorectal function, and an additional 36 age-matched normal subjects were collected as a control group. The study group had a significant decrement of maximum basal pressure (MBP), 42.6±27.0 mm Hg, in PSS as compared with the control group, 71.2±24.9 mm Hg (P=.0004). The difference in the functional length (FL) of the anal canal, PSS∶control=2.4±1.0 cm∶3.7±0.5 cm (P=.0001); the volume of first defecating sensation, PSS∶control=66.3 ±35.2 ml∶125.1±43.8 ml; the voluntary component, the difference between maximum squeeze pressure (MSP) and MBP, PSS∶control=116.6±73.6 mm Hg∶61.8±35.9 mm Hg (P=.0087), were also found to be statistically significant. Nevertheless, the MSP and maximal tolerable capacity (Vmax) showed no difference in these two groups (MSP, PSS∶control=159.3±88.1 mm Hg∶132.9±44.9 mm Hg,P=.259), (Vmax, PSS∶control=193.1±67.7 ml∶230.0±60.9 ml,P=.0526), Twelve (71 percent) of 17 patients did not have rectoanal inhibitory reflex, and paradoxical contraction during rectal balloon inflation was noted in ten patients. Nine patients had different degrees of anal incontinence and abnormal anometric profiles were found in six of eight asymptomatic patients. Therefore, only two patients (12 percent) had neither symptoms nor anometric evidence of anorectal involvement in PSS. Two patients with long-standing disease received posterior anal repair for stool incontinence, the postoperative results were satisfactory both subjectively and objectively. The average MBP increased from 0 to 20 mm Hg, average FL from 0 to 1.5 cm. Patients complained less frequently about stool incontinence or soiling, and their daily life is now more comfortable. The analysis indicates that anorectal function in PSS is affected much more frequently and earlier than thought. Anorectal manometry can be used as an adjuvant in diagnosing controversial cases. Once anal incontinence occurs, posterior anal repair can achieve good results after six months of follow-up.     

慢性功能性便秘肛直肠压力检测及EMG生物反馈训练疗效的研究

目的探讨慢性功能性便秘(CFC)患者肛直肠压力及肌电(EMG)活动特点,同时观察生物反馈训练系统对CFC患者的疗效及对上述指标的影响.方法用BIOLAB动力学参数监测系统(液态式),多道胃肠功能检查仪对144例CFC患者检测,并用OrionPC/12mEMG生物反馈治疗仪进行肌电评估和训练,20例健康者作对照.结果与健康对照组相比,CFC患者肛管静息压稍下降(P＞0.01)、最大缩榨压明显降低(P＜0.01),直肠感知阈和最大耐受量均显著增高(P＜0.01);EMG评估CFC患者盆底肌与腹前斜肌有矛盾运动100%,其运动幅值盆底肌静息状态下升高(P＜0.01)和腹前斜肌降低(P＜0.01);OrionPC/12mEMG生物反馈训练治疗后可显著改善CF C患者上述异常改变(P＜0.01),生物反馈治疗CFC患者临床症状改善,总有效率为84.03%,增加疗程的频次、缩短治疗间隔以及辅助家庭训练等可以提高疗效和降低复发率(P＜0.01).结论CFC患者存在肛门直肠动力、感知觉及肌电活动异常,OrionPC/12mEMG生物反馈系统可以改善上述异常表现,对84.03%的CFC患者具有良好的疗效,较长时间的强化训练可望提高近期疗效,辅助家庭训练可降低复发率.     

帕金森病伴便秘与功能性便秘的直肠肛门测压特点分析

 目的观察帕金森病(PD)伴便秘患者与功能性便秘(FC)患者的直肠肛门动力和感觉功能及其异同。方法顺序纳入男性PD伴便秘患者15例及男性FC患者45例,均经全结肠镜或结肠钡灌肠除外肠道器质性疾病。经直肠肛门测压,分析患者直肠肛门动力参数及感觉参数,将排便障碍患者进一步分为排便协同障碍(F3a)及排便推进力不足(F3b)两种亚型。结果PD伴便秘组年龄(70±11)岁,FC组年龄为(68±11)岁,差异无统计学意义。PD伴便秘组直肠静息压较FC组偏高[9.0(4.0,15.0)mmHg比6.0(3.0,9.5)mmHg,1mmHg=0.133kPa],但差异无统计学意义(P=0.082);两组肛管静息压的差异无统计学意义[(51.2±17.2)mmHg比(59.7±20.4)mmHg,P=0.152]。缩紧肛门时,PD伴便秘组的肛管最大缩榨压及持续缩榨曲线下面积均显著低于FC组[(136.9±43.8)mmHg比(183.0±62.1)mmHg,P=0.010;(823.5±635.7)mmHg·s比(1392.4±939.9)mmHg·s,P=0.033]。模拟排便时,PD伴便秘组的直肠力排压及肛管力排剩余压也明显低于FC组[22.0(15.0,30.0)mmHg比42.0(31.0,55.0)mmHg,P=0.000;(46.3±23.3)mmHg比(77.9±35.1)mmHg,P=0.002];两组力排时的直肠肛管压差均为负值,异于正常排便压差,但两组间差异无统计学意义。PD伴便秘患者排便障碍以F3b型为主(10/15);FC组中以F3a型多见[46.7%(21/45)];但两组的排便障碍类型构成比的差异无统计学意义(P=0.120)。PD伴便秘患者及FC患者的直肠扩张初始感觉阈值分别为(91.3±56.9)ml与(67.2±38.9)ml,均高于正常参考值,但两组间差异尚无统计学意义(P=0.074)。结论PD伴便秘患者及FC患者均存在直肠肛门动力和感觉异常。与FC患者相比,PD伴便秘患者的缩肛及力排的重要参数值明显降低,且测压分型以F3b型为主,感觉阈值有升高趋势。上述指标可作为PD伴便秘患者直肠肛门测压的特征参数,对PD发病机制的理解及其与相关疾病的鉴别可起重要作用。     

慢性特发性便秘患者肛门直肠测压表现及西沙必利的疗效研究

目的研究慢性特发性便秘（CIC）患者肛门直肠动力及直肠对容量刺激感觉的变化，同时观察西沙必利对CIC的疗效及对上述指标的影响。方法用肛门直肠测压法检测30例CIC患者，服用西沙必利前后的直肠动力及直肠对容量刺激感觉的变化。20名健康者作对照。结果肛门直肠括约肌最大收缩压降低（P＜0．05），引起直肠肛门抑制性反射的最小松弛容量（MRV）增大（P＜0．05），直肠内部容量刺激的排便阈值及疼痛阈值均明显增加（P＜0．01）；西沙必利10mg每日3次治疗4周可显著改善CIC患者上述异常改变（P＜0．01），增加CIC患者排便次数（P＜0．01），治疗总有效率为46，67％。结论CIC患者存在肛门直肠动力及内脏感觉异常，西沙必利可改善上述异常表现，对约半数CIC患者具有良好疗效。