便秘主导型肠易激综合征患者结、直肠肛门动力学的临床研究--附50例检测分析

目的:研究便秘主导型肠易激综合征患者的结肠、直肠动力和直肠感觉功能.方法:用不透X线法的结肠传输试验检测50例便秘主导型肠易激综合征(constipation predominant irritable bowel syndrom,C-IBS)患者及42名正常受试者(对照组)的结肠传输时间(colonic transit time,CTT)和结肠传输指数(transit index,TI),并用结肠传输指数分型;同时用肛门直肠测压方法测定C-IBS患者和对照组的肛门直肠压力、直肠感觉阈值和直肠顺应性.结果:C-IBS患者的全结肠及各节段结肠传输时间均高于对照组,C-IBS患者的肛管静息压、直肠静息压与对照组比较差异均无统计学意义(P＞0.05),肛门括约肌最大收缩压低于对照组,最大耐受容量及直肠顺应性均明显高于对照组(P＜0.01),且发现不同传输类型的C-IBS患者的肛门直肠测压的结果不尽相同.结论:C-IBS患者存在结肠、肛门直肠动力及直肠感觉功能异常,结肠传输试验与肛门直肠测压相结合,更有助于明确便秘的类型.     

The Role of Magnetic Resonance Imaging Defecography in the Evaluation of Patients With Chronic Constipation

IntroductionPelvic floor dysfunction is one of the major causes of primary chronic constipation. Our study aims to assess utility of defecography using magnetic resonance imaging (MRI) in assessing pelvic floor dysfunction in these patients.MethodsMR defecography studies of 50 patients with chronic constipation done on 1.5 T/3 T MRI machines were analyzed retrospectively. Midline sagittal images were evaluated during rest, strain, and defecation phases.ResultsOf 50 patients, 62% had only compartment III involved, 8% had compartments II and III involved, 8% had compartments I and III involved, and 16% had all 3 compartments involved, the remaining 6% had no compartment involvement. Of the 21 patients with rectocele, anterior rectocele was more common than posterior. Anorectal angles were compared with the three grades of anorectal descent. Both moderate and severe grades of anorectal descent had an abnormal angle.ConclusionDynamic MR defecography helps identify pelvic floor dysfunction in patients with chronic constipation and helps design surgical repair to avoid recurrence.     

盆底疝、直肠黏膜内脱垂合并慢传输型便秘患者的护理

目的研究手术治疗盆底疝、直肠黏膜内脱垂合并慢传输型便秘的围手术期护理特点。方法选择20例盆底疝、直肠黏膜内脱垂合并慢传输型便秘患者,根据围手术期各期的特点,进行针对性的护理,并观察对患者手术效果的影响。结果18例术后恢复正常排便,2例行需辅助泻剂排便,但用量明显减少。结论加强围手术期护理对盆底疝、直肠黏膜内脱垂合并结肠慢传输所致顽固性便秘手术患者恢复有促进作用。     

Colonic transit time and constipation in children with spastic cerebral palsy

OBJECTIVES: To evaluate colonic motility and to investigate contributing factors to colonic dysmotility in children with spastic cerebral palsy (CP). DESIGN: Cross-sectional study. SETTING: A university-based rehabilitation hospital. PARTICIPANTS: Thirty-eight children with spastic CP. INTERVENTIONS: Not applicable.MAIN OUTCOME MEASURES: Colonic transit time was measured by using a Sitzmarks. The nutrient intake during 3 consecutive days was analyzed by using the ESHA Food Processor program. RESULTS: A significant relationship between colon transit time and stool frequency was observed (P<.05). All children with constipation and 17 (60.8%) of 28 without constipation showed an abnormal segmental colon transit time in at least 1 segment of the colon. A transit time delay at the proximal segment of colon was remarkable in CP children with constipation. In children without constipation, a transit time delay was marked at the rectosigmoid colon only. Constipation and transit time delay were significantly related to ambulatory function (P<.05). CONCLUSIONS: A transit time delay at total or segmental colon was frequently observed in children with CP. Constipation and colonic motility were related to ambulatory function.     

盆底疝、直肠黏膜内脱垂合并慢传输型便秘患者的护理

目的 研究手术治疗盆底疝、直肠黏膜内脱垂合并慢传输型便秘的围手术期护理特点.方法 选择20例盆底疝、直肠黏膜内脱垂合并慢传输型便秘患者,根据围手术期各期的特点,进行针对性的护理,并观察对患者手术效果的影响.结果 18例术后恢复正常排便,2例行需辅助泻剂排便.但用量明显减少.结论 加强围手术期护理对盆底疝、直肠黏膜内脱垂合并结肠慢传输所致顽固性便秘手术患者恢复有促进作用.     

Surgical management of colonic inertia

Fourteen patients with chronic constipation due to colonic inertia were treated with total abdominal colectomy and ileorectal anastomosis at the Cleveland Clinic Foundation from 1981 to 1986. All patients were white women ranging in age from 28 to 64 years (mean 41 years). The duration of symptoms averaged 21 years (range six to 47 years) and the average time between bowel movements was ten days. The preoperative evaluation included barium enema in 12 patients and colonoscopy in five (some patients had both studies). Anorectal dysfunction was excluded by manometry in ten patients and by rectal biopsy in six. Colonic transit studies were accomplished in only two patients. The hospital stay averaged 13 days, and there was no operative mortality. Postoperative morbidity included one case of small bowel obstruction, necessitating operative correction on postoperative day 9. Follow-up ranged from three months to five years. At their last clinic visit, the patients averaged two bowel movements per day. All patients had excellent bowel control and were happy with the procedure.     

功能性结肠运输时间延长与便秘的相关性

目的：通过回顾性比较分析，探讨结肠运输试验检查在便秘病因学诊断所起的作用。方法：收集3年中根据Agachan计分确定为便秘并至少做过一次结肠运输实验的病人87例，分为：A组，全结肠运输时间正常组；B组，全结肠运输时间延长组。比较分析各组乙直肠运输占全结肠运输的比（简称乙全比）值过小的情况。结果：A组32例，占总例数的36．8％；B组55例，占63．2％。A组乙全比过小者的有10例，占31．3％；B组9例，占16．4％。经χ^2检验，A、B两组之间的差异显著（P＜0．01）。结论：结肠运输蝗测定对于便秘病因的确定有重大帮助，其中乙直肠运输功能的测定至关重要。     

生物反馈训练治疗慢性功能性便秘的临床研究

目的：随机对照研究、评估生物反馈训练治疗慢性功能性便秘的疗效。方法：60例慢性功能性便秘患者,随机分为治疗组30例和对照组30例。治疗组接受1个疗程（5周）生物反馈训练治疗（10次为一个疗程、一次30～45分钟、每周2次）。对照组患者接受聚乙二醇400010gBID口服,疗程5周。治疗前后作便秘症状评分、结肠通过试验检测、直肠肛门压力检测。结果：生物反馈训练和聚乙二醇4000均可使多数慢性功能性便秘患者的大便次数、大便性状及伴随症状恢复正常或缓解,总有效率分别为66.7%和80%（P〉0.05）。生物反馈训练和聚乙二醇4000口服治疗后,结肠通过试验72小时标志物排出率分别为75%及73%,均较治疗前明显增加。生物反馈训练治疗后力排时肛门压明显下降。结论：生物反馈训练对出口梗阻型、慢传输型便秘均有效,是一种有效的、新兴的治疗慢性功能性便秘的方法,可作为功能性便秘的一线治疗方法。     

Women’s perception of postpartum pelvic floor dysfunction and their help‐seeking behaviour: a qualitative interview study

Scand J Caring Sci; 2013; 27; 406–413 Women’s perception of postpartum pelvic floor dysfunction and their help‐seeking behaviour: a qualitative interview study Aims: To explore women’s perception of postpartum pelvic floor dysfunction and their help‐seeking behaviour. Methods: We interviewed 26 patients from two family practitioners’ populations in the Netherlands 1 month to 1 year after their vaginal delivery. The semi‐structured interviews were independently encoded and analysed by three researchers according to a scoring list on determined topics. Three researchers independently coded themes discussed by the interviewees that matched main topics from the interview guide. In the case of encoding differences, the researchers deliberated on them until consensus was reached. Findings: All women suffered from pelvic floor dysfunction such as urinary incontinence, pelvic floor pain, prolapse, haemorrhoids, anal fissure, constipation and dyspareunia. Midwives and gynaecologists did not prepare them for postpartum pelvic floor problems. The women did not expect the problems to be that severe. They hoped their problems would improve by themselves. The women talked to close initiates (female relatives and friends who had had deliveries themselves), who confirmed that the problems were an inevitable consequence of vaginal delivery and that there were no real treatment options. The women indicated they needed professional information about their pelvic floor problems but were ashamed to talk about them outside their inner circle. Conclusions: These women are uninformed about postpartum pelvic floor problems. They discuss their pelvic floor dysfunction with close initiates who feed their hope that the problems will resolve spontaneously. The women are not stimulated to seek professional help. However, the women do indicate they need professional information. They want to understand their problems and know how to deal with them. It is time for doctors and midwives to focus on the mother’s health after delivery so that mothers will suffer less from pelvic floor problems, have more awareness of what they can do about them and call in medical aid.     

女性盆底肌力检测及临床分析

背景：了解女性盆底功能障碍性疾病在新疆多民族聚集区的发病相关因素、探寻能相对准确反映盆底功能的量化检查方法,对此病的三级预防起到不可或缺的作用。目的：探讨女性盆底肌力的相关因素,并分析盆底肌力测定与女性盆底功能障碍性疾病临床症状、体征的相关性及临床意义。方法：通过问卷调查、体格检查、盆底肌力检测收集2010年4至11月于新疆医科大学第一附属医院妇科住院女性患者资料共210例。采用秩和检验对分组变量进行分析,对有统计学意义的资料再进行Spearman秩相关分析。结果与结论：年龄、体质量指数、不同分娩次数、绝经、慢性便秘持续时间与盆底肌力呈负相关性;压力性尿失禁症状、盆腔器官脱垂体征与盆底肌力均存在负相关性。提示：控制体质量,减少慢性便秘的发生;做好围绝经期激素替代治疗;从产科因素控制孕产妇盆底组织受损程度,引起患者对自身盆底肌力的重视,利于盆底功能障碍性疾病提早预防及治疗。     

结肠慢传输型便秘手术方式的选择

目的 分析总结结肠慢传输型便秘手术方式的选择.方法 对结肠慢传输型便秘外科治疗患者术前检查、诊断、手术方式和治疗效果等临床资料进行回顾性分析.结果 顽固性便秘患者经电子结肠镜、结肠传输试验和排粪造影等检查确诊结肠慢传输型便秘47例,行全结肠切除回肠直肠吻合术9例,次全结肠切除盲肠直肠吻合术28例,结肠旷置术10例;合并出口梗阻37例,同时行直肠黏膜切除硬化剂注射15例、直肠前突修补术7例、盆底抬高盆底疝修补加直肠悬吊术10例、子宫悬吊术3例、扩肛治疗2例.术后发生粘连性肠梗阻1例,无其它手术并发症.术后6个月,达到排便1~3次/d.结论 术前仔细检查,制定个体化的手术方案,结肠慢传输型便秘外科治疗效果满意.     

Biofeedback: its role in the treatment of chronic constipation.

Constipation accounts for more than 2.5 million physician visits a year. Treatment of constipation has been a long-standing and costly problem. Affecting approximately 4.5 million Americans, predominantly women and the elderly, constipation can be persistent and difficult to manage. With the great number of laxative products available, more than $350 to $400 million is spent on over-the-counter laxatives each year. In addition to a complete history and physical examination, tests of anorectal function are useful in the assessment of defecation disorders. Approximately 50% of patients exhibit uncoordinated or dyssynergic defecation patterns. Biofeedback therapy may improve the symptoms of these patients. Biofeedback therapy is labor-intensive, expensive, and available only at a few centers. Although the concept of dyssynergic defecation has existed for only a few years, its therapy, based on neuromuscular conditioning, is gaining recognition. The biofeedback program from one Midwestern tertiary care center is described. Although much still needs to be learned regarding the etiology and pathophysiology of dyssynergic defecation, its management with biofeedback is shown to be efficacious and may prove to be the treatment of choice for patients with this dysfunction of the pelvic floor.     

生物反馈治疗对功能性便秘患者肛管直肠动力的影响

目的研究生物反馈治疗前后功能性便秘患者肛管直肠动力参数的改变,探索生物反馈治疗功能性便秘的临床疗效。方法对42例慢性功能性便秘患者给予生物反馈治疗,治疗前后进行临床评估、肛管直肠测压及肌电图检查并进行对比分析。结果生物反馈治疗后患者临床症状改善,肛管直肠测压显示直肠感觉阈值、直肠最大容量感觉阈值、肛管直肠抑制反射阈值有所下降（P〈0．05）,而直肠静息压、肛管静息压及肛管最大收缩压虽有增高,但与治疗前相比差异无统计学意义（均P〉0．05）,肌电图显示盆底肌和腹肌的矛盾运动消失。结论功能性便秘患者存在肛直肠动力异常,有盆底肌和腹肌的矛盾运动,生物反馈治疗能有效改善功能性便秘患者的肛直肠动力障碍。     

Pelvic floor outcomes in patients who have undergone general rehabilitation following surgery for colorectal cancer: a pilot study北大核心CSCD

BACKGROUND There is a paucity of evidence on changes in pelvic floor outcomes in patients with colorectal cancer (CRC) following general oncology rehabilitation. OBJECTIVE In patients following surgery for CRC, to explore changes in pelvic floor muscle function before and after a general oncology rehabilitation program;and to compare pelvic floor symptoms in patients undergoing the rehabilitation program to a matched control group. METHODS This pilot study was conducted as an observational study nested within a prospective study evaluating the feasibility of a general oncology rehabilitation program for patients following surgery for abdomino-pelvic cancer. In this nested study, pelvic floormuscle function was measured in 10 participants with CRC (rehabilitation group) before and immediately after the 8-week rehabilitationprogram and at 6-month follow-up. Data of 10 matched participants from the prospective study who completed questionnaires only at the same assessment time points were used as a control group.     

Constipation

Most patients with chronic constipation respond to dietary measures, fiber supplements, or laxatives. For those who do not, diagnostic tests of colonic and anorectal function help to select appropriate treatments. Therapeutic options, pharmacologic agents, and surgery, the last resort, are discussed in this article.     

盆底超声诊断盆腔功能障碍性疾病的应用价值

目的：探讨盆底超声在孕龄期妇女盆底结构变化及盆腔功能障碍性疾病中的应用价值。方法：应用经会阴盆底超声测量167例单胎、顺产孕妇各孕期膀胱颈移动度（BND）、宫颈外口移动度（CD）、膀胱后角（RVA）、盆膈裂孔面积（LHA）、前后径（LR）、横径（HA），分析产程特点与产后盆底结构异常类型，总结盆腔功能障碍性疾病的发生与康复效能的对比。结果：盆底超声指标BND、CD、RVA、LHA、LR、HA随孕周增加而增加，组间对比差异于孕晚期开始出现（P＜0.05）；观察组内比较，孕晚期、产时、产后与孕早期、中期有统计学差异，且在产时达到最大（P＜0.05），孕早期与孕中期无统计学差异（P＞0.05）；产后与对照组有统计学差异（P＜0.05）；较长产程及机械助产与产后盆底结构异常存在相关性；参与盆底功能康复治疗的女性盆底功能障碍性疾病发生率明显低于未参与者，差异有统计学意义（P＜0.05）。结论：妊娠和阴道分娩可影响女性盆底结构，增加盆底功能障碍性疾病的发生风险，盆底超声能直观反映妊娠期、产时及产后女性的盆底结构，且具有无创、无辐射、可重复等突出优势，对预防及诊断妊娠期、产后女性盆底功能障碍性疾病的发生有重要临床意义。     

保留结肠的盲直肠端侧吻合术治疗结肠慢传输型便秘

目的探寻结肠慢传输型便秘创伤较小的手术方法。方法对 12例经结肠传输试验诊断为结肠慢传输型便秘的患者施行盲直肠端侧吻合术 ,将结肠病变肠段旷置而不作次全或全部切除 ,术后观察患者便秘的缓解情况 ,并与行结肠次全切除、盲直肠端端吻合术的 3 4例患者作对照。结果治疗组手术均成功 ,术中时间平均 85分钟 ,失血量 72 .7ml,术后无肠梗阻出现 ,大便 1～ 3次 /d ;对照组手术成功 3 3例 (1例因肠吻合口梗阻 ,次日行结肠造口 ) ,术中时间平均174分钟 ,失血量 3 10ml,大便 1～ 5次 /d ;两组均随访 1年 ,无症状复发者。结论保留结肠的盲直肠端侧吻合术治疗结肠慢传输型便秘疗效确切 ,创伤小 ,手术时间短 ,值得临床推广     

Long-term survival of patients with anorexia nervosa: a population-based study in Rochester,Minn

OBJECTIVE: To estimate long-term survival of unselected patients with anorexia nervosa from Rochester, Minn. PATIENTS AND METHODS: In this population-based retrospective cohort study, all 208 Rochester residents who presented with anorexia nervosa (193 women and 15 men) for the first time from 1935 through 1989 were monitored for up to 63 years. Subsequent survival was compared with that expected for Minnesota white residents of similar age and sex, and standardized mortality ratios were determined on the basis of age- and sex-specific death rates for the US population in 1987. RESULTS: Survival was not worse than expected in this cohort (P = .16). The estimated survival 30 years after the initial diagnosis of anorexia nervosa was 93% (95% confidence interval, 88%-97%) compared with an expected 94%. During 5646 person-years of follow-up (median, 22 years per patient), 17 deaths occurred (14 women and 3 men) compared with an expected 23.7 deaths (standardized mortality ratio, 0.71; 95% confidence interval, 0.42-1.09). One woman died of complications of anorexia nervosa, 2 women committed suicide, and 6 patients (5 women and 1 man) died of complications of alcoholism. Other causes of death were not increased. CONCLUSIONS: Long-term survival of Rochester patients with anorexia nervosa did not differ from that expected. This finding suggests that overall mortality was not increased among the spectrum of cases representative of the community.