生物反馈治疗大便失禁的疗效评价

目的　评价生物反馈方法治疗大便失禁患者的疗效。方法　对 2 6例大便失禁患者进行生物反馈治疗 ,治疗前后分别做肛肠测压和肌电图检查 ,评价患者的肛门功能。结果　 2 6例患者肛管最大收缩压、收缩肌电振幅、持续收缩时间、直肠感觉阈值和感觉收缩时间治疗前、后均有显著差异 (P <0 .0 1)。结论　生物反馈治疗大便失禁有效     

老年骨性关节炎的诊治进展

骨性关节炎是多发于中年以后的慢性 ,退行性关节疾病 ,多累及手的小关节和身体负重关节。临床上以关节疼痛、变形和活动受限为特点。病理变化最初发生于软骨 ,以后侵犯软骨下骨板以及滑膜等关节周围组织 ,可见局灶性、侵蚀性软骨破坏 ,软骨下硬化 ,囊性变和代偿性骨赘形成等病理变化。发病机制尚不清楚 ,一般认为与衰老、创伤、炎症、肥胖、代谢障碍和遗传等因素有关。1　流行病学骨关节炎发病与年龄有关 ,4 0岁以下较为少见。以放射学方法 ,对德国 6 5 85名居民的调查表明 ,6 0～ 70岁者 75 %皆有远端指间关节骨关节炎。女性患骨关节炎者明…     

呼吸机相关性肺炎的流行病学和诊治进展

呼吸机相关性肺炎发病率逐年增高,致残率、致死率也呈上升趋势.本文通过对呼吸机相关性肺炎的发病机制、发病相关因素及病原体流行病学的分析,总结呼吸机相关性肺炎的诊疗进展及目前主要的治疗方案.     

老年人的便秘和大便失禁

美国≤65岁的人群中患便秘者约占2％,之后随年龄增长而增多。西方老年人便秘的发生率约20％～25％。在急诊入院老年病人中占41％,而长期住院的老年病人,便秘的发生率则高达80％以上。 便秘的发病机理 在大多数老年便秘者找不到明显病理性病变。便秘可以是代谢内分泌病如糖尿病、甲状腺机能减退。高钙血症和结肠疾病、神经精神     

系统性红斑狼疮相关胰腺炎诊治进展

系统性红斑狼疮(systemic lupus erythematosus, SLE)是一种以致病性自身抗体和免疫复合物形成并可介导多器官组织损伤的自身免疫性疾病,临床上常出现多系统受累。SLE相关性胰腺炎是SLE的严重并发症,易误诊、漏诊,治疗困难,预后不佳。因此,本文对SLE相关性胰腺炎的最新研究进展进行综述,旨在提高临床医师对SLE相关性胰腺炎的认识和诊治水平。     

早泄的诊治进展

早泄 (Prmature ejaculation,PE)是射精障碍的一种类型。早泄可分为原发性早泄 (PPE,自性活动开始就出现早泄 )和继发性早泄 (SPE,有正常性活动者在一段正常性活动后出现的早泄 )。近年来 ,有关早泄的诊治研究进展很快 ,笔者就此作一综述。1　早泄的诊断PPE与 SPE的区分有助于病因诊断及处理。目前研究认为 ,精神生理学方法能客观评价男子性功能障碍 ,不但可提示性反应中认识、情感、精神方面对性的影响 ,还可以特制的神经生理仪测定患者阴茎感觉传导反应 ,以明确 PE患者涉及性反应的神经肌肉有关器质性差异。常用方法为阴茎生物震感…     

肺栓塞诊治进展

肺动脉栓塞简称肺栓塞 (Pulmonary Embolism,PE) ,是指内源性或外源性栓子 (以血栓最常见 )堵塞肺动脉及其分支引起的肺循环障碍的一种临床病理综合征。1　流行病学我国迄今尚无确切的肺栓塞流行病学资料。阜外医院报告的 90 0余例心肺血管病尸检资料中 ,肺段以上栓塞者达 10 0例 (11% ) ,其中风心病尸检达 2 9% ,心肌病达 2 6% ,肺心病达 19% ,说明心肺血管疾病是肺栓塞的主要危险因素。国外肺栓塞发病率、病死率都很高。美国每年肺栓塞发病率约 65万之多 ,其中死亡约 2 5万人 ,占全部疾病死亡原因的第三位。 70年代以来 ,肺栓塞有增加趋…     

Pharmacotherapy for Fecal Incontinence: A Review

Fecal incontinence is a common clinical problem that often is frustrating to the patient and treating physician. Nonsurgical management for fecal incontinence includes dietary manipulation, Kegel exercises, perianal skin care, and biofeedback therapy. Pharmacotherapies often are used to assist in management of fecal incontinence. A variety of pharmacotherapies have been utilized for the management of fecal incontinence; limited data from randomized, placebo-controlled trials are available. This is a review of the existing literature on clinical trials of several classes of drugs and other medical therapies that may be beneficial for patients with fecal incontinence. The information in this article was obtained by a MEDLINE search for all clinical trials of drug therapy for fecal incontinence. These treatments and the existing data on their use are summarized. Treatments reviewed include stool bulking agents, with an emphasis on the most promising effect obtained with calcium polycarbophil, constipating agents, including loperamide, codeine, amitriptyline, atropine, and diphenoxylate agents injected into the anal sphincter, drugs to enhance anal sphincter function, including topical phenylepherine and oral sodium valproate, and trials of fecal disimpaction. A new classification to easily remember the treatment categories for this condition, based on the "ABCs of treatment for fecal incontinence," has been introduced into the structure of this review.     

The Efficacy of Biofeedback Treatment in Patients with Fecal Incontinence

Background: The initial treatment for fecal incontinence (FI) includes supportive treatment and medical treatment. If the initial treatment fails, biofeedback therapy (BFT) is recommended. However, there are limited and conflicting results in the literature supporting the beneficial effect of BFT for FI. The aim of the study is to analyze the efficacy of BFT in 126 patients who have FI due to several causes.Methods: The data of 126 patients (88 females (69.8%) and 38 males (30.2%)) were collected retrospectively. Colonoscopy, anorectal manometry (ARM), and 3D-Endoanal ultrasonography (EAUS) were performed for all patients before applying BFT. In addition, all patients received toilet training instruction and training in Kegel and other pelvic floor strengthening exercises from an experienced nurse, before BFT.Results: The median age of participants was 54 years (range 18-75 years). While 80 patients (63.5%) had clinical and manometric benefit from BFT, 46 patients (36.5%) did not respond to BFT. According to the EAUS and ARM findings, BFT was beneficial in patients who had partial external sphincter failure, and was unsuccessful in patients who had both internal and external sphincter failure, both internal and external sphincter tears, and external sphincter tear rates of more than 25%. After BFT, significant increases in squeeze pressures were observed, with this increase being higher in the positive-response group.Conclusion: The results suggest that BFT is effective in the treatment of FI for specific patient populations.     

Telephone vs. Face-to-Face Biofeedback for Fecal Incontinence: Comparison of Two Techniques in 239 Patients

PURPOSE Biofeedback is an effective treatment for patients with fecal incontinence, yet little is known about how it works or the minimum regime necessary to provide clinical benefit. This study compares the effectiveness of a novel protocol of telephone-assisted biofeedback treatment for patients living in rural and remote areas with the standard face-to-face protocol for patients with fecal incontinence. METHODS A new treatment program comprising an initial face-to-face assessment and treatment with transanal manometry and ultrasound biofeedback, followed by three treatments conducted via telephone and a final face-to-face assessment, was developed. Standard treatment involved five face-to-face treatment sessions with manometry and ultrasound. Patients from rural areas were offered the telephone-assisted treatment protocol. Data gathered prospectively included incontinence scores, a quality of life index, anal manometry, and external sphincter isometric and isotonic fatigue times. RESULTS A total of 239 consecutive patients treated between July 2001 and July 2004 were enrolled. There were no significant differences in demographic details, past history, or pretreatment measures of the two groups. Forty-six of 55 patients (84 percent) treated with the telephone protocol and 129 of 184 (70 percent) treated by the standard technique completed treatment. There were substantial, significant improvements after treatment, including 54 percent mean improvement in patient’s own rating of their incontinence in both groups; a mean decrease of 3.1 and 3.2 on the St. Mark’s incontinence score (from 7.9 to 4.7 and 7.4 to 4.2 of 13) and relative improvements of 128 and 130 percent in the quality of life index (from 0.29 to 0.65 and 0.3 to 0.69 of 1) for the telephone-assisted and standard groups respectively. Importantly, there were no significant differences between the telephone-assisted or standard groups in any outcome. Of patients who completed treatment, 78 percent were better or much better. CONCLUSIONS A less intensive regime of biofeedback seems to be equally effective as the standard intensive protocol. This finding adds weight to the evolving concept that the physical aspects of biofeedback treatment, such as manometry or ultrasound, may not be necessary in the treatment of most patients with fecal incontinence. This needs to be further tested in a randomized, controlled trial. Dr. Byrne was supported by the Notaras Fellowship from the University of Sydney and the Training Board of the Colorectal Surgical Society of Australasia. Reprints are not available.     

Antegrade Continence Enema in the Treatment of Congenital Fecal Incontinence Beyond Childhood

Purpose  The role of antegrade continence enema for the treatment of congenital fecal incontinence in adult patients remains unclear. Materials  Twenty-seven patients, median age 19 (range, 17–43) years, with congenital fecal incontinence underwent surgery for antegrade continence enema and were prospectively followed up for functional outcome after a median of 25 (range, 3–117) months. Results  The diagnoses included myelodysplasia (n = 14), anorectal malformations (n = 6), and others (n = 7). Antegrade continence enema conduits included appendicostomy (n = 22) and cecal (n = 2), ileal (n = 2), and sigmoid (n = 1) tubes. Thirteen (48 percent) patients had complications. Eighteen (66 percent) patients became fully continent, six (23 percent) had minor, and three (11 percent) major soiling. Antegrade continence enema became unnecessary in three patients (11 percent). Treatment with antegrade continence enema failed in three cases. Of the 21 patients who continued with antegrade continence enema, 16 (76 percent) are fully continent, and bowel function and quality of life was improved in 15 (71 percent) and 13 (62 percent) patients, respectively. The scores of convenience (1 = easy, 5 = difficult) and overall satisfaction (1 = poor, 10 = excellent) were median 2 (range, 1–4) and 8 (range, 3–10). Conclusions  Despite numerous complications and occasional treatment failures, 90 percent of adult patients with congenital fecal incontinence benefited from antegrade continence enema. Reprints are not available     

Carbon-Coated Microbeads Anal Injection in Outpatient Treatment of Minor Fecal Incontinence

Purpose

Anal bulking agents are injected to pose a stronger obstacle to the involuntary passage of feces and gas. This prospective, multicenter study was designed to evaluate the safety and efficacy of Durasphere® anal injection for the treatment of fecal incontinence.

Patients and Methods

Thirty-three unselected patients with incontinence (24 females; mean age, 61.5?±?14 (range, 22–83) years) underwent anal bulking agent submucosal injection with carbon-coated microbeads (Durasphere®) in the outpatient regimen. The causes of incontinence were obstetric lesions in 18.2 percent, iatrogenic in 36.4 percent, rectal surgery in 12.1 percent, and idiopathic in 33.3 percent. Previous unsuccessful treatments for fecal incontinence included diet and drugs in 16 patients, biofeedback training in 7 patients, sacral nerve modulation in 6 patients, sphincteroplasty in 2 patients, artificial bowel sphincter in 1 patient, and PTQ macroplastique bulking agent in 1 patient. Under local anesthesia and antibiotic prophylaxis, a mean of 8.8 (range, 2–19) ml of Durasphere® were injected into the submucosa by using a 1.5-inch, angled, 18-gauge needle.

Results

After a median follow-up of 20.8 (range, 10–22) months, the median Cleveland Clinic continence score decreased significantly from 12 to 8 (P?P?=?0.0074), but the Fecal Incontinence Quality of Life did not change significantly (74 to 76, P = not significant). Anal manometry significantly improved (resting pressure increasing from 34 to 42 mmHg; P?=?0.008) and squeezing pressure from 66 to 79 mmHg (P?=?0.04). Two patients complained of moderate anal pain for a few days after the implant, one patient had asymptomatic leakage of the injected material through a mucosa perforation, and two had distal migration of the Durasphere® along the dentate line.

Conclusions

Anal bulking agent injection is a safe treatment and can mitigate the severity of fecal incontinence by increasing anal pressure but does not significantly improve the quality of life.     

Overt Rectal Prolapse and Fecal Incontinence

PURPOSE  Rectal prolapse is frequently associated with fecal incontinence; however, the relationship is questionable. The study was designed to evaluate fecal incontinence in a large consecutive series of patients who suffered from rectal prolapse, focusing on both past history, anal physiology, and imaging. METHODS  Eighty-eight consecutive patients who suffered from an overt rectal prolapse (72 women, 16 men; mean age, 51.1 ± 19.5 years) as a main symptom were analyzed; 48 patients also experienced fecal incontinence compared with 40 without incontinence. Logistic regression analyses were performed. RESULTS  The two groups of patients did not differ with respect to parity, weekly stool frequency, main duration of symptoms before referral, occurrence of dyschezia, and digital help to defecate. Patients with prolapse who were older than 45 years (odds ratio (OR), 4.51 (1.49–13.62); P = 0.007) and those with a past history of hemorrhoidectomy (OR, 9.05 (1.68–48.8); P = 0.01) were significantly more incontinent. Incontinent group showed frequent internal anal sphincter defect compared with the continent group (60 vs. 6.2 percent; P = 0.0018). CONCLUSIONS  In patients with overt rectal prolapse, the occurrence of fecal incontinence needs special consideration for age and previous hemorrhoid surgery as causative factors. Anal weakness and sphincter defects are frequently observed.