经会阴3D超声探查对便秘的产后妇女盆底变化的探讨

目的：了解经会阴3D超声探查产后妇女便秘的盆底变化。方法：选取2012年1月-2013年12月本院收治的40例产后妇女,随机分为有便秘症状组和没有便秘症状组各20例,观察Valsalva动作前、后、中盆腔的情况,静息、Valsalva动作时的肛提肌裂孔的变化。结果：有便秘症状组在盆底超声检查中出现盆底结构异常改变的例数明显高于没有便秘症状组,有便秘症状组无论是静息或Valsalva动作时肛提肌的前后径、左右径、面积及周长均明显大于没有便秘症状组,差异均有统计学意义（P〈0.05）。结论：经会阴3D超声探查产后妇女便秘的盆底变化具有一定的临床指导意义。     

Chronic functional constipation in adolescents: clinical findings and motility studies

OBJECTIVE: To evaluate the clinical findings and colonic transit time in adolescents with chronic functional constipation. METHODS: Forty-eight consecutive adolescents with chronic functional constipation referred to the Gastroenterology Service at the Hospital de Clínicas de Porto Alegre, Brazil were studied. Clinical parameters were assessed using a questionnaire. Total and segmental colonic transit time were measured with radiopaque markers. RESULTS: Mean age at first visit was 14 +/- 2 years, and age at onset of constipation was 6 +/- 4 years; 90% of patients depended on laxatives, and 86% on intermittent enemas; 76% had a family history of constipation. There was no statistical difference in the amount of daily fiber ingested by patients and controls. Measurements of colonic transit time revealed that 60% of patients had slow transit constipation, 13% had pelvic floor dysfunction, 10% had slow transit constipation associated with pelvic floor dysfunction, and 17% had a normal colonic transit time. Decreased frequency of evacuation and palpable abdominal fecal mass were significantly associated with slow transit constipation. CONCLUSIONS: Functional constipation in adolescence consists of a heterogeneous group of colonic functional disorders. The identification of these different functional disorders in adolescents will guide specific treatment, which may prevent the progression of this symptom into adult life.     

Gastrointestinal surgery and gastroenterology. X. Obstipation: treatment

Treatment of the symptom of constipation is usually symptomatic. Correction of abnormal lifestyle and dietary habits may constitute a sufficient treatment of constipation. In addition, bulk-forming agents and osmotically active laxatives may be used. Only when these measurements are insufficiently effective, may more drastic treatment options such as contact laxatives and enemas may be used. In cases of spastic pelvic floor syndrome physiotherapy of the pelvic floor is indicated.     

Effectiveness of pinaverium bromide therapy on colonic motility disorders in irritable bowel syndrome

The special patterns of the slow wave activity in irrittable bowel syndrome by means of surface electromyography were examined and the effect of pinaverium bromide on the symptoms and on the colonic motility in this disease was estimated. Twenty two patients with irritable bowel syndrome and 7 healthy controls were selected to the study. The clinical symptoms were abdominal pain and bloating in all patients, constipation in 9, and diarrhoea in 6 cases. Surface electromyography was carried out before and on the 14th day of the treatment with pinaverium bromide (50 mg t. i. d). The colonic motility was analysed in a 2 hour fasting and a 2 hour postprandial period following a standard (800 kCal) meal. The slow wave frequency of 0.01-0.04 Hz were selected and analysed. The mean frequency of activity peaks (n/10 min) and power-index (area under curve, microV 10 min) were measured. For statistical analysis Student's t-test was applied. Electromyogram of patients with irritable bowel syndrome showed a significant increase of the measured colonic motility parameters both in fasting and postprandial states. Fourteen days of pinaverium bromide treatment was able to significantly reduce the intensity of the colonic motor activity. Administration of pinaverium bromide completely released in 6 and significantly improved the abdominal pain in other 12 patients, while the bloating disappeared in 12 and was significantly improved in 5 from 22 patients. Pinaverium bromide was able to normalise the stool frequency: the weekly number of stools was decreased from 16 to 7 in the patients complaining diarrhoea ant it was increased from 2 to 6 in the patients with constipation.     

武汉市围绝经期妇女压力性尿失禁患病率及影响因素的调查

目的调查武汉市围绝经期妇女压力性尿失禁(stress urinary incontinence,SUI)的患病率及影响因素。方法 2014年4~10月,对武汉市常青花园社区卫生服务中心参加健康检查的40~65岁妇女采用自拟问卷调查其基本特征及尿失禁症状,分析影响SUI的危险因素。结果 1 067名受调查者中SUI的患病率为32.24%。单因素逻辑分析结果显示:高血压、心脏病、萎缩性阴道炎、便秘、盆腔器官脱垂是SUI的危险因素(P0.05);多因素逻辑分析结果显示:心脏病、便秘、盆腔器官脱垂是SUI的独立危险因素(P0.05)。结论武汉社区围绝经期妇女SUI发病率高,SUI的潜在危险因素有高血压、心脏病、萎缩性阴道炎、便秘和盆腔器官脱垂。     

The end to the myth that hysterectomy has negative effects on the function of pelvic organs

Hysterectomy is sometimes considered the starting point of pelvic floor symptoms, such as urinary incontinence, constipation and sexual disturbances. However, it is questionable whether there is a causal relationship. Such an effect was not found in numerous prospective controlled studies. There is a striking discrepancy between prospective controlled studies and retrospective and cross-sectional studies in this regard. Retrospective and cross-sectional studies frequently report a negative effect of hysterectomy on pelvic organ function. On the basis of the recent literature it may be concluded that non-radical hysterectomy has no detrimental effect on pelvic organ functions.     

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.     

The diagnostic value of symptoms for the identification of patients with an increased risk of colorectal disease. A criteria-based analysis.

In most textbooks of gastroenterology, diseases with their symptoms are discussed. The exact diagnostic value of these symptoms, however, regarding the differentiation between organic and functional disease, is not mentioned. A criteria-based meta-analysis of the few existing studies in this field was done. From the 14 identified studies, there were two that did not find any significant symptoms. In the other studies the diagnostic value of colonic symptoms showed great variability. Methodological deficiencies in these studies are probably responsible for the latter. The generalization of these results into general practice is not straightforward and needs research in general practice patients.     

Defecometry: determination of objective parameters of defecation

A method is presented for the identification and analysis of constipation due to difficult evacuation of rectal content. This condition--which has not been elucidated by former techniques--was identified in 5 out of the 19 constipated patients by this new method. Disturbed defecation was characterized by prolonged evacuation of the simulated stool and the greater work performed during this process. The cause of this phenomenon was the paradox movement of the pelvic floor, i.e. contraction instead of relaxation. The results' highlight: the excessive straining can induce a neuromuscular damage to the pelvic floor. The clinical importance of this method lies in the clarification of the principle, that the therapy of this condition must be initiated as early as possible.     

子宫切除术与盆底功能障碍性疾病的关系研究进展

盆底功能障碍（pelvic floor dysfunetion,PFD）是由多种病因导致的盆底支持组织薄弱,进而致盆腔脏器移位连锁引发的其他盆腔器官位置和功能异常。子宫切除术是治疗子宫良性病变较常用方法,与手术相关的盆底损伤,可致盆底功能障碍,进而引发盆底功能障碍性疾病。本文就子宫切除术与女性盆底功能障碍性疾病的关系进行综述如下。     

Unifying concept of pelvic floor disorders and incontinence.

Denervation of pelvic floor sphincter muscles is a feature of pelvic floor disorders. When severe, it may be accompanied by stress incontinence of faeces, or of urine. The extent of chronic partial denervation of these pelvic floor muscles can be quantified by electromyography (EMG), and its cause identified by electrophysiological studies of the motor innervation of these striated muscles. Damage to this innervation is often initiated by childbirth, but appears to progress during a period of many years so that the functional disorder usually presents in middle life. Incontinence develops in some patients, but not in others. This can be predicted by the severity of the abnormalities found in EMG studies of the pelvic sphincter musculature and motor latency studies of its innervation. The results of such investigations in the six common types of pelvic floor disorder are presented. Recognition of the causative factors leading to damage to the innervation of the pelvic sphincter muscles implies new approaches to treatment and to prevention of pelvic floor disorders and incontinence.     

探讨不同康复方法对产后妇女盆底肌力的恢复效果

目的探讨不同康复方法对产后妇女盆底肌力的恢复效果。方法选取深圳市宝安区妇幼保健院2015年1月至2016年3月足月阴道分娩6周后盆底功能评定异常的产妇400例为研究对象,根据患者意愿分为A、B、C 3组。A组130例行Kegel训练,B组130例在Kegel训练基础上加盆底生物电治疗,C组140例在B组基础上加低频脉冲治疗,治疗8周后对3组患者进行肌力评估。结果 C组总有效率(95.71%)明显高于A、B组(80.00%、86.92%),差异有统计学意义(P0.05);治疗前3组盆底肌力评分比较差异无统计学意义(P0.05),治疗8周后B、C组疗效优于A组,C组优于B组,差异有统计学意义(P0.05);治疗前3组生活质量评分比较差异无统计学意义(P0.05),治疗后评分改善,且B、C组高于A组,C组高于B组,差异有统计学意义(P0.05)。结论盆底康复治疗中,Kegel训练联合低频脉冲及盆底生物电治疗疗效最佳,但盆底生物电治疗费用高昂,仪器设备沉重,需要产妇去医院,可操作性差,不利于在家庭中推广;低频脉冲治疗仪可有效缓解症状,提升盆底肌力,改善患者生活质量,且仪器携带方便、价格低廉,操作简单,值得推广。     

Indications for and results of operation in inflammatory bowel disease.

Of 363 patients with inflammatory bowel disease presenting between 1972 and 1983, 166 required definitive operation. A classification by histological type distinguishes Crohn's disease (CD) from ulcerative colitis (UC) and indeterminate inflammatory bowel disease. CD is divided into predominantly ileal disease (81), total or subtotal colonic disease (74) and distal disease (22), whilst UC is classified into colonic (95) or distal disease (63). Most patients with ileal disease required operation for chronic persistent symptoms. In patients with total colonic involvement a greater proportion of patients with CD than those with UC came to surgery. Very few patients with distal disease required surgery. After resection for ileal disease there was a low incidence of anastomotic leakage (3%) and no operative mortality. There was an overall operative mortality of 8% after colonic resection. This was much lower in the non-urgent cases but rose to 12% in urgent cases.     

盆底康复联合雌雄激素治疗盆底功能障碍性疾病的临床观察

目的探讨盆底康复联合雌雄激素治疗盆底功能障碍性疾病的效果。方法收集我院160例围绝经期盆底功能障碍性疾病患者,随机分为两组,治疗组予以盆底康复仪联合雌雄激素治疗,对照组单纯采用盆底康复仪治疗。观察两组治疗前后盆底肌力及疲劳度的变化(用统一的盆底肌肉治疗头压力型检测器),并在治疗期间于同一月经周期抽取治疗组患者血清检测雌雄激素水平,以观测本课题临床治疗过程中激素剂量的合理性。结果治疗1个疗程后,两组盆底综合肌力及症状均较治疗前改善(P<0.05),其中治疗组较对照组改善更显著(P<0.05)。且课题中激素用量合理。结论盆底康复治疗结合激素对治疗盆底功能障碍性疾病有很好疗效。     

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.     

老年女性盆腔器官脱垂发病的相关危险因素研究

目的:探讨老年女性盆腔器官脱垂发病的危险因素,为其预防提供理论依据。方法:采用成组病例对照研究的方法,从医院收集146例盆腔脏器脱垂患者,以年龄为匹配条件,从体检中心选择292例健康体检者作为对照组。设计调查问卷,对两组妇女进行调查。结果:经过多因素非条件Logistic回归分析显示:BMI>24(OR=4.456,95%CI:0.327～1.946),产次(OR=3.246,95.0%CI:0.425～8.343),慢性咳嗽(OR=2.347,95.0%CI:0.567～13.364),便秘(OR=2.342,95.0CI%:0.457～14.354),盆腔手术史(OR=3.735,95.0%CI:0.952～7.853)是盆腔器官脱垂发生的危险因素。结论:BMI>24,产次,慢性咳嗽,便秘,盆腔手术史是盆腔器官脱垂的独立危险因素。     

Bowel dysfunction in multiple sclerosis

Bowel symptoms are seen in two thirds of multiple sclerosis (MS) patients, constipation and fecal incontinence, frequently coexisting, being the major symptoms. Since bowel symptoms are common in community, the need for precise definitions of pathology are stressed. Pathophysiological studies of bowel function are reviewed and the following hypothesis is suggested: Constipation is caused by a delay in colonic transit time, by a delay in the defecation reflex and by early external sphincter exitation. Fecal urgency/incontinence may be explained by impaired rectal sensation, not warning the patient to seek the toilet in time. Decrease in rectal compliance and in some patients abnormal rectal contractions may facilitate fecal expulsion and weak external sphincters allow leakage. Treatment options are commented and the need for treatment studies stressed.     

盆底综合康复治疗对老年女性尿失禁的相关研究

目的探讨盆底综合康复治疗对老年女性压力性尿失禁患者的临床疗效及其对焦虑抑郁情绪的影响。方法选取2015年7月~2016年7月在北京老年医院妇科就诊的老年女性轻中度压力性尿失禁患者80例,随机分为试验组和观照组各40例。分别用生物反馈电刺激联合盆底肌肉锻炼法及单独的盆底肌肉锻炼法进行治疗并随访,比较两组尿失禁的治愈率、自觉症状评分及焦虑抑郁评分的改变。结果采用盆底综合康复治疗的试验组治疗后和随访后的尿失禁治愈率分别为90%(36/40)和72.5%(29/40),均显著高于对照组(P0.05)。试验组治疗后和随访后的症状评分均显著低于治疗前(P0.05)。试验组在治疗后及随访后的焦虑自评量表评分和老年抑郁评分均显著低于治疗前及同时期的对照组(P0.05)。结论盆底综合康复治疗更有效地改善老年女性压力性尿失禁的症状,同时减轻患者焦虑抑郁的负面情绪。     

生物反馈电刺激治疗盆底功能障碍性疾病的临床研究

目的 探讨生物反馈电刺激治疗女性盆底功能障碍性疾病的效果.方法 对54例女性盆底功能障碍性疾病患者进行生物反馈电刺激治疗,不同患者采用不同的频率、脉宽.结果 除压力性尿失禁(SUI)患者没有治愈外,盆腔器官脱垂(POP)患者治愈率为10.0%(1/10),产后盆底损伤患者治愈率为100.0%(32/32).SUI患者显效率为91.7%(11/12),POP患者显效率为70.0%(7/10),总有效率为94.4%(51/54).结论 生物反馈电刺激治疗女性盆底功能障碍性疾病,能降低盆底功能障碍性疾病的发病率,提高女性患者的生活质量,有着广泛的临床应用前景.     

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.