Should patients with combined colonic inertia and nonrelaxing pelvic floor undergo subtotal colectomy?

PURPOSE: Treatment of severe constipation caused by combined colonic inertia and nonrelaxing pelvic floor is controversial. This study is designed to evaluate the outcome of preoperative biofeedback and subtotal colectomy for patients with combined colonic inertia and nonrelaxing pelvic floor. METHODS: One hundred six patients who underwent subtotal colectomy for intractable constipation from 1982 through 1995 answered a detailed questionnaire regarding postoperative bowel function, symptoms of abdominal pain and bloating, and degree of satisfaction after the operation. Sixteen of these patients had a combination of colonic inertia and nonrelaxing pelvic floor diagnosed by transit marker study, electromyography, and defecography. These patients completed preoperative biofeedback training. RESULTS: Electromyographic relaxation of pelvic floor musculature was demonstrated after the biofeedback treatment in all patients, but symptoms of difficult evacuation persisted. Postoperatively, seven patients (43 percent) had complete resolution of symptoms of constipation or difficult evacuation. Six patients still complained of incomplete evacuation that was severe in two and unresponsive to postoperative biofeedback. Three patients (18 percent) complained of diarrhea (>5 bowel movements per day) and incontinence of liquid stools (at least one episode a week). Nine patients (56 percent) were satisfied despite persistent symptoms. CONCLUSIONS: Subtotal colectomy can improve some symptoms in patients with slow transit constipation and nonrelaxing pelvic floor. However, incomplete evacuation persists in a significant number of patients and almost one-half of patients are dissatisfied with their surgery.     

Long-term results of subtotal colectomy with cecorectal anastomosis for isolated colonic inertia

AIM: To evaluate the results of sub total colectomy with cecorectal anastomosis (STC-CRA) for isolated colonic inertia (CI). METHODS: Fourteen patients (mean age 57.5 ± 16.5 year) underwent surgery for isolated CI between January 1986 and December 2002. The mean frequency of bowel motions with the aid of laxatives was 1.2 ± 0.6 per week. All subjects underwent colonoscopy, anorectal manometry, cinedefaecography and colonic transit time (CTT). CI was defined as diffuse markers delay on CTT without evidence of pelvic floor dysfunction. All patients underwent STC- CRA. Long-term follow-up was obtained prospectively by clinical visits between October 2005 and February 2006 at a mean of 10.5 ± 3.6 years (range 5-16 years) during which we considered the number of stool emissions, the presence of abdominal pain or digitations, the use of pain killers, laxatives and/or fibers. Patients were also asked if they were satisfied with the surgery. RESULTS: There was no postoperative mortality. Postoperative complications occurred in 21.4% (3/14). At the end of follow-up, bowel frequency was significantly (P < 0.05) increased to a mean of 4.8 ± 7.5 per day (range 1-30). One patient reported disabling diarrhea. Two patients used laxatives less than three times per month without complaining of what they called constipation. Overall, 78.5% of patients would have chosen surgery again if necessary. CONCLUSION: STC-CRA is feasible and safe in patientswith CI achieving 79% of success at a mean follow- up of 10.5 years. A prospective controlled evaluation is warranted to verify the advantages of this surgical approach in patients with CI.     

Reduced Expression of Serotonin Receptor(s) in the Left Colon of Patients With Colonic Inertia

PURPOSE: Serotonin regulates colonic motility via receptors expressed on neural fibers and smooth muscle. Colonic inertia is characterized by delayed colonic transit. Abnormalities in serotonin receptor protein, as judged by immunoreactivity levels, could contribute to the origin of colonic inertia. The aim of this study was to investigate the expression of serotonin receptor(s) immunoreactivity in the left colon of patients with colonic inertia compared with controls. METHODS: Sixteen patients who underwent subtotal colectomy for colonic inertia were assessed. Colonic transit time was measured with the radiopaque marker technique and presented as the number of retained markers in the colon on Day 5. The control group consisted of 18 patients who underwent left hemicolectomy for colonic carcinoma; histologically normal tissues from the left colon were used. Immunohistochemical staining for serotonin receptor was performed with a rabbit anti-idiotypic antibody. The average positive area (square pixels) in the mucosa, muscularis mucosa, submucosa, and circular and longitudinal muscles per microscopic field (63×) was calculated based on measurement of the positively stained area in 20 randomly chosen microscopic fields in each related structure. The Scion Image computer analysis system was used. RESULTS: Serotonin receptor(s) immunoreactivity was mainly detected in the muscular mucosa, circular muscles, and longitudinal muscles and rarely in the mucosa and submucosa. In muscularis mucosa and circular muscle, the positive areas were significantly less in the colonic inertia group than in controls (muscularis mucosa: 29.1 ± 10.8 vs. 109.7 ± 28.2, P < 0.05; circular muscle: 25.6 ± 6.2 vs.90.2 ± 19.1, P < 0.01). There were significantly positive correlations in the control group in serotonin receptor(s) immunoreactivity levels between circular muscle and longitudinal muscle (r = 0.54, P < 0.05) and between muscular mucosa and longitudinal muscle (r = 0.57, P < 0.05) but not in colonic inertia patients. In addition, the positive areas in the circular muscle were positively correlated to the colonic transit time (Spearmans rank correlation, 0.83; P < 0.01). CONCLUSION: In colonic inertia patients, the serotonin receptor(s) immunoreactivity level is lower in muscular mucosa and circular muscle. The absence of a correlation of serotonin receptor(s) immunoreactivity in the muscular mucosa and muscularis propria in the patient group implies that an uncoordinated expression of serotonin receptors may also contribute to colonic inertia. However, the positive correlation between serotonin receptor(s) immunoreactivity levels in the circular muscle and the transit time observed in colonic inertia patients suggests a decrease in stimulatory subtypes and at the same time an increase in inhibitory subtypes of serotonin receptors in this tissue.     

Quality of life after colectomy for colonic inertia

Background Total abdominal colectomy (TAC) with ileorectal anastomosis represents the procedure of choice in patients with colonic inertia and relieves constipation in the majority of patients. The aim of this study was to assess postoperative long–term health related quality of life in these patients in relation to their functional outcome. Methods A consecutive series of patients with isolated colonic inertia who underwent TAC between 1993 and 1999 was identified from a clinical database and investigated in a cohort outcome study. Functional variables including the weekly number of bowel movements (BM), abdominal pain, bloating and distension, fecal incontinence, and the use of medications for BM assistance were assessed preoperatively and postoperatively. Main outcome measure was healthrelated quality of life assessed at follow–up using the SF–36 Health Survey. Results A total of 17 women with a mean age of 47.8 years (SD=14.3 years) were assessed and were followed postoperatively for 58.3±27.3 months. Preoperatively, all patients were constipated with less than one bowel movement per week, used laxatives, and experienced abdominal pain, bloating and distension. Postoperatively, all patients had some relief of constipation symptoms, with 3.7±2.8 bowel movements/day; 41% complained of abdominal pain, 65% of bloating, 29% required BM assistance, and 47% had occasional incontinence to gas or liquid stool. The SF–36 scores were significantly lower than those of the general population (p<0.005). In univariate regression analysis, postoperative abdominal pain was predictive for lower scores in general health and vitality and the need for BM assistance for lower scores in physical role functioning, social functioning, and emotional role limitations. Conclusions After TAC, quality of life is significantly reduced in patients with colonic inertia despite successful relief of symptoms of constipation. Postoperative pain and functional impairment are predictive of lower quality of life scores. Note This study was reported in part as an oral presentation at the Annual Meeting of the American Society of Colon and Rectal Surgeons, 2–8 June 2002, Chicago, USA, and as a poster at the Annual Meeting of the Association of Coloproctology of Great Britain and Ireland, Manchester, United Kingdom, 2–5 July 2002.     

老年慢性特发性便秘患者结肠动力学变化

目的：探讨老年慢性特发性便秘（ＣＩＣ）患者结肠运行功能变化及其与心理因素的关系,方法：应用不透Ｘ线标记物法及Ｚung抑郁自评量表（ＳＤＳ）及焦虎自评量表（ＳＡＳ）对５９例老年ＣＩＣ患者及３６例老年对照者进行结肠通过时间检查及心理状况分析,结果：（１）老年ＣＩＣ组全结肠及分段结肠通过时间较老年对照组明显延长（Ｐ＜０．０５）,（２）长期服用泻药组的老年ＣＩＣ患者其全结肠及分段结肠通过时间较间断服药和不服药者明显延长（Ｐ＜０．０５）,（３）老年ＣＩＣ患者ＳＤＳ,ＳＡＳ标准总分均明显高于对照组（Ｐ＜０．０５,（４）老年ＣＩＣ患者中结肠通过时间延长组ＳＤＳ标准通过时间延长组（Ｐ＜０．０５）,结论：老年ＣＩＣ患者存在结肠动力学异常,抑郁情绪和焦虑情绪与老年ＣＩＣ患者结肠运行功能异常有关。     

老年特发性便秘患者结肠、直肠和肛门动力学变化

目的　探讨老年慢性特发性便秘 (CIC)患者结肠、直肠和肛门运动功能变化。方法　应用不透 X线标记物法 ,采用 8通道水灌注式消化道压力检测系统 ,对 5 9例老年慢性特发性便秘 (CIC)患者及 36例对照者进行结肠通过时间检查及直肠肛门压力测定。结果　 1老年 CIC组全结肠及分段结肠通过时间较对照组明显延长(P<0 .0 5 ) ;2长期服用泻药的老年 CIC患者其全结肠通过时间较间断服药和不服药组明显延长 (P<0 .0 5 ) ;3老年 CIC患者最大缩榨压、模拟排便时肛管压力变化低于对照组 (P<0 .0 5 ) ,直肠初始感觉阈值、排便阈值和最大耐受容量均高于对照组 (P<0 .0 5 ) ,并有 2 8例 (4 7.5 % )老年 CIC患者模拟排便时出现肛管压力异常升高。结论　老年 CIC患者存在结肠动力学异常 ,与直肠低敏感、高耐受及排便时直肠肛管运动不协调有关     

5-羟色胺与结肠动力关系研究

5-羟色胺(5-HT)参与调节肠道多种功能。5-HT制剂广泛用于临床治疗结肠动力相关性疾病,但具体作用机制不甚清楚。本文围绕5-HT与结肠动力的关系进行综述。     

Effects of rectal mobilization and lateral ligaments division on colonic and anorectal function

PURPOSE: Colonic and anorectal function are altered after posterior rectopexy. The aim of this randomized, prospective study was to evaluate the effects of rectal mobilization and division of the lateral ligaments on colonic and anorectal function. METHODS: Posterior rectopexy was performed in 18 patients with complete rectal prolapse. Anal manometry and measurement of rectal compliance, total and segmental colonic transit time, constipation score, and defecation frequency were performed preoperatively and three months postoperatively. Ligaments were divided in ten patients. RESULTS: Mean preoperative total transit time was similar between the two patient groups and doubled postoperatively (P=0.03). Mean postoperative segmental transit time increased by a factor of 1.7 in segments I (ascending colon) and II (descending colon) and by a factor of 2.3 in segment III (rectosigmoid). The same pattern was found in both groups. Mean resting pressure decreased after division of the lateral ligaments and increased after preservation. Mean rectal compliance decreased after division of the ligaments and increased when they were preserved. Mean postoperative constipation score differed little from the preoperative score. Mean defecation frequency was decreased in the group with the ligaments preserved and increased in the group with the ligaments divided. None of the effects of rectal mobilization or division of the lateral ligaments on anorectal function reached statistical significance. CONCLUSION: Rectal mobilization had a statistically significant effect on colonic function. Total and segmental colonic transit times doubled. The effects on anorectal function were not significant. Division of the lateral ligaments did not significantly influence postoperative functional outcome.     

Colonic transit time of radiopaque markers and rectoanal manometry in patients complaining of constipation

Transit time, rectoanal manometry, and symptoms were studied in 61 patients complaining of constipation. A slow transit, in the colonic area of most of the patients, was found in 49. Rectoanal manometry was abnormal in 40. Both examinations were abnormal in 32 patients, colonic transit only in 17, and manometry only in eight. Finally, both examinations were normal in only four subjects. A transit delay was always associated with less than three stools per week, and straining at stool was constant when rectoanal manometric disturbances were shown. Objective abnormalities appear common in patients complaining of constipation and, correlated with symptoms, suggest that clinical study in constipation could be of more value than usually is believed.     

Patients with irritable bowel syndrome and constipation are more depressed than patients with functional constipation

BackgroundPsychosocial factors, such as depression, have been shown to be associated with gastrointestinal disorders like constipation.MethodsWe retrospectively compared the depression and anxiety profiles of patients with irritable bowel syndrome with constipation versus those of patients with functional constipation using validated questionnaires. Subjects rated the intensity of digestive symptoms experienced during the previous month using visual analogue scales. Colonic transit time measurements and anorectal manometry were performed.ResultsOf the 128 consecutive, constipated patients included (84% females, mean age 49.7 ± 15.5 years) 66 suffered from irritable bowel syndrome with constipation and 62 from functional constipation. Demographic and physiological traits were similar in the two groups. Patients suffering from irritable bowel syndrome with constipation reported higher depression scores (18.8 ± 1.4 vs 12.7 ± 1.3, P = 0.002) and higher symptom intensity scores for constipation (6.2 ± 0.3 vs 4.3 ± 0.4, P < 0.001), bloating (6.7 ± 0.3 vs 3.3 ± 0.4, P < 0.001) and abdominal pain (6.0 ± 0.3 vs 2.7 ± 0.4, P < 0.001) than patients with functional constipation. Multiple linear regression showed positive correlations between symptom intensity and depression and anxiety scores for functionally constipated patients only.ConclusionsOur results support the integration of a psychosocial component to the traditional treatment of constipated patients; however, further research exploring causality between psychosocial factors and specific gastrointestinal disorders would contribute to developing a tailored therapeutic approach.     

不同亚型肠易激综合征患者大肠黏膜组织蛋白质组双向凝胶电泳分析

目的 分析不同亚型肠易激综合征（IBS）患者与正常人大肠黏膜组织蛋白质组表达的差异。方法 采用双向凝胶电泳（2-DE）技术和计算机辅助的图像分析方法，对腹泻型IBS（D-IBS）和便秘型IBS（C-IBS）患者与正常人大肠黏膜组织蛋白质进行分离和比较分析。结果 D-IBS组与正常人大肠黏膜组织比较有11个蛋白点表达明显增强，未发现明显低表达的蛋白质点。C-IBS组与正常人大肠黏膜组织比较有18个蛋白质点的表达存在明显差异，其中有3个蛋白点表达发生明显上调，有15个蛋白点表达发生明显下调。有1个蛋白点表达在D-IBS和C-IBS组均增强；有3个蛋白点在C-IBS组表达减弱，在D-IBS组表达增强。结论 D-IBS、C-IBS患者与正常人大肠黏膜组织蛋白质表达存在明显差异，可能与IBS的发病机制有关；不同亚型IBS的发病机制可能存在不同的分子基础。     

Laparoscopic-assisted surgery for constipation

The aim of this study was to evaluate the safety, outcome and disability of various forms of laparoscopic-assisted colectomy for constipation. Between August 1991 and February 1995, 14 patients with constipation who underwent laparoscopic assisted total abdominal colectomy with ileorectal anastomosis (TAC + IR) or sigmoidectomy with colorectal anastomosis (SC + CR) with or without rectopexy were analyzed. Parameters included age, sex, preoperative medical treatment and evaluation, constipation score, indication for surgery, procedure performed, length of surgery, postoperative ileus, and hospitalization as well as morbidity, cosmesis, functional outcome and return to partial and full activity. Surgery was undertaken for colonic inertia (6 patients) and obstructing sigmoidocele with or without prolapse (8 patients) in 12 females and 2 males with a mean age of 47.5 (range 22–77) years. The mean history of laxative- or enema-dependent constipation was 18.3 (range 7–35) years and the mean constipation score was 24.4 (range 20–29). The overall mean operating time was 217.5 (range 125–325) min; 260 (range 195–315) min in the patients with TAC + IR, and 185.6 (range 125–325) min in the patients with SC + CR with or without rectopexy (P < 0.05). The mean length of postoperative ileus was 3.8 (range 2–7) days, and the length of hospitalization was 7.6 (range 4–15) days. There were 3 (21%) cases of intraoperative complications, and 4 cases of (29%) postoperative complications. At a mean follow-up of 37.8 (range 18–60) months, the mean frequency of bowel movements had increased from 2.5 per week preoperatively to 8.4 per week postoperatively (P < 0.0001). Ten patients reported excellent or good results relative to cosmesis. The mean time to return to partial activity was 1.7 (range 1–3) weeks, and return to full activity was 5.1 (range 3–10) weeks. Although laparoscopic procedures for constipation have definite advantages including better cosmesis and more rapid return to partial and full acitivity, disadvantages include the long operating time that may preclude its routine application. Received: 31 March 1999 / Accepted: 3 June 1999     

Immunoglobulin-containing cells in the colonic mucosa of rabbits with carrageenan-induced colitis

Immunohistochemical analysis of immunocompetent cells in the colonic mucosa was performed with carrageenan-induced experimental colitis in rabbits. Colitis was induced by seven months of oral administration of λ-degraded carrageenan following immunization with the same substances containing Freund's complete adjuvant. In the colonic mucosa with colitis, IgG- and IgM-containing cells were significantly increased in number (IgG: 540±94/mm² in experimental group,vs. 120±54/mm² in control,P<.05, IgM: 55.0±19.7/mm² in experimental group,vs. 6.7±2.4/mm² in control,P<.05). There was no significant increase of IgA-containing cells either in number or in proportion to the total mononuclear cells. These changes, induced by carrageenan in rabbits, had resembled those in human ulcerative colitis well. These observations suggested an impairment of the IgA-regualted local immune system and an abnormality in the differentiation process of immunoglobulin-secreting cells. Supported in part by Japanese Ministry of Public Welfare grant (research group on disturbance of digestion and absorption).     

改良结肠运输试验在慢性便秘鉴别诊断及治疗中的价值

目的探讨改良结肠运输试验对慢性便秘鉴别诊断及指导治疗中的价值。 方法选取2013年1月至2015年6月,江苏省苏北人民医院胃肠外科便秘专科门诊诊治的慢性便秘患者52例,对52例不同程度排便困难患者和10例健康对照者进行改良结肠运输试验,即在禁食促排便药物72 h后行上消化道钡餐检查,6 h和72 h后再分别拍摄腹部平片,观察钡剂在肠道残留情况,根据检查结果分类并予以相关治疗。 结果所有患者未见胃肠道器质性病变。7 h后,10例健康对照者肠道内无钡剂残留,39例患者钡剂残留在结肠（诊断为慢传输型）,5例患者钡剂残留在直肠（诊断为出口梗阻型）,而8例患者钡剂残留在结直肠内（诊断为混合型）。所有患者予以促结肠动力药物普芦卡必利（2 mg/d）±乳果糖（30 mg/d）治疗,其中1例慢传输型患者、1例出口梗阻型患者和8例混合型患者无效,予以施行腹腔镜下金陵术治愈。 结论改良结肠运输试验对慢性便秘的诊断具有重要价值,有助于不同便秘类型的鉴别及针对性治疗。     

Decreased expression of serotonin in the jejunum and increased numbers of mast cells in the terminal ileum in patients with irritable bowel syndrome

AIM： To investigate if there are changes in serotonin （5-HT） levels, enterochromaffin （EC） cells and mast cells in small intestinal mucosa of patients with irritable bowel syndrome （IBS）. METHODS： Diarrhea-predominant （IBS-D, n = 20）, or constipation-predominant （IBS-C, n = 18） IBS patients and healthy controls （n = 20） underwent colonoscopy and peroral small intestinal endoscopy, and mucosal samples were obtained at the descending part of the duodenum, proximal end of jejunum and terminal ileum. High-performance liquid chromatographyelectrochemistry and immunohistochemical methods were used to detect 5-HT content, EC cells and mast cells. RESULTS： （1） There were no differences in the number and distribution of EC cells between IBS patients and the normal group. （2） The mucosal 5-HT contents at the duodenum, jejunum and ileum in IBS-C patients were 182 ± 90, 122 ± 54, 61 ± 35 ng/mg protein, respectively, which were all lower than those in the normal group （256 ± 84, 188 ± 91, and 93 ± 45 ng/ mg protein, respectively）, with a significant difference at the jejunum （P 〈 0.05）. There were no differences in the small intestinal mucosal 5-HT contents between IBS-D patients and the normal group. The mucosal 5-HT contents at the duodenum were significantly higher than those at the ileum in the three groups （P 〈 0.001）. （3） The numbers of mast cells in patients with IBS-C and IBS-D at the ileum were 38.7 ± 9.4 and 35.8 ± 5.5/highpower field （hpf）, respectively, which were significantly more than that in the normal group （29.8 ± 4.4/hpf） （P 〈 0.001）. There was no significant difference in the numbers of mast cells at the other two parts between IBS patients and the normal group. The numbers of mast cells in IBS-C, IBS-D, and normal groups were all significantly higher at the ileum （38.7 ± 9.4, 35.8 ± 5.5, 29.8 ±4.4/hpf, respectively） than at the duodenum （19.6± 4.7, 18.5 ± 6.3, 19.2 ±3.3/hpf, respectively, P 〈 0.001）. CONCLUSIO     

Analysis of patients with poor outcome of rectocele repair

PURPOSE: The aim of the present study was to analyze the prognostic value of clinical data and physiologic tests in patients undergoing rectocele repair for obstructed defecation. METHODS: Between 1988 and 1996, 89 consecutive female patients with obstructed defecation caused by a rectocele were enrolled in the study. Median age at time of presentation was 55 (range, 35–81) years. All patients underwent a combined transvaginal and transanal rectocele repair. End evaluation to assess long-term results was performed by an independent observer after a median duration of follow up of 52 (range, 12–92) months. The presence of the following five symptoms was evaluated: prolonged and unsuccessful straining at stool, feelings of incomplete evacuation, manual assistance during defecation, false urge to defecate, and a stool frequency of less than three times per week. When none or just one of these symptoms was present, outcome of rectocele repair was considered successful. The outcome was considered as a failure when two or more of these symptoms were recorded. Furthermore, all patients were asked to score the outcome of their operations as excellent, good, moderate, or poor. Clinical data and the results of physiologic tests obtained in patients with a poor outcome of surgery were compared with those obtained in patients with a successful outcome. RESULTS: Objective outcome of rectocele repair, based on the presence of symptoms, was found to be successful in 63 (71 percent) patients. Sixty-one patients considered outcome of surgery excellent or good (69 percent). Graded subjective outcomes between the two groups showed significantly better grades in cases of success. Duration of symptoms, number of symptoms, age, parity, and previous hysterectomy had no influence on the final outcome of surgery. Defecographic parameters, such as size of the rectocele, barium trapping in the rectocele, poor rectal evacuation, or intussusception, had no prognostic value. Signs of anismus based on defecography, electromyography, and balloon-expulsion studies did not influence outcome of surgery. The presence of symptoms such as defecation frequency, manual assistance, severe straining, false urge to defecate, or feelings of incomplete evacuation had no impact on the outcome. However, in patients without a daily urge to defecate or with a stool frequency of less than once per week, results of rectocele repair were significantly worse than in patients with a daily urge to defecate or a defecation frequency of more than once per week or both. In 14 of 26 patients with a poor outcome, colonic transit studies were performed. A delayed passage was observed throughout the entire colon in seven patients, in the left part of the colon and the rectosigmoid colon in four patients, and in the rectosigmoid colon in one patient. In two patients colonic transit was normal. CONCLUSIONS: Combined transvaginal and transanal rectocele repair is beneficial for the majority of patients with obstructed defecation. In patients without a daily urge to defecate or a stool frequency of less than once per week, indicating colonic malfunctioning, the outcome of rectocele repair seems to be poor.     

替加色罗对老年功能性便秘患者肛门直肠动力和直肠感觉功能的影响

目的研究老年功能性便秘(简称便秘)患者肛门直肠动力和直肠感觉功能改变及替加色罗的影响。方法采用瑞典CTD-SYNECTICS公司生产的PC-Polygraf HR高分辨多道胃肠功能消化道检测仪,对便秘患者(老年30例、非老年22例)和健康对照者(老年28例、非老年20例)肛门直肠动力和直肠感觉功能进行检测,同时便秘患者给予替加色罗口服(商品名:泽马可,北京诺华制药有限公司制造,6mg,2次／d),两周后复查肛门直肠动力和直肠感觉功能。结果(1)老年便秘患者直肠最低敏感量、最大耐受性、最大顺应性和模拟大便直肠及括约肌同步收缩发生率分别为(200±61)ml、(280±69)m1、(40．5±10．8)ml／kPa、46．7％,高于老年对照组(95±31)ml、(205±78) ml、(32．9±12．9)ml／kPa、14．2％;非老年便秘组上述指标[(140±52)ml、(250±58)ml、(38．6±12．3)ml／kPa、36．2％]亦高于非老年对照组[(75±38)ml、(190±50)ml、(30．8±15．2)ml／kPa、0．0％],均为P<0．01;(2)老年和非老年对照组肛门括约肌压力分别为(4．9±0．8)kPa和(6.6±1．3)kPa,缩窄压为(9．3±1．6)kPa和(13．3±1．9)kPa,老年对照组低于非老年对照组(均为P< 0．01);(3)老年和非老年便秘组服药后直肠最低敏感量、最大耐受性、最大顺应性和模拟大便直肠及括约肌同步收缩发生率明显低于服药前(P<0．01)。结论(1)老年功能性便秘患者直肠对容量刺激存在低敏感、高耐受、高顺应性,且肛门、直肠的协调收缩功能紊乱;(2)健康老年人直肠对容量刺激敏感性降低,肛门自控能力减弱;(3)替加色罗有改善功能性便秘患者直肠感觉功能及促进肛门、直肠协调收缩作用。     

肠易激综合征患者小肠黏膜5-HT信号系统的研究

目的探讨肠易激综合征（IBS）患者不同部位小肠黏膜5-羟色胺（5-HT）水平及肠嗜铬细胞（EC细胞）数量是否改变。方法选取24例便秘型IBS（IBS-C）、26例腹泻型IBS（IBS-D）患者和26名健康人,行小肠镜及结肠镜检查并取十二指肠降段、近端空肠和回肠末段黏膜,用高压液相色谱-电化学法和免疫组织化学检测5-HT含量和EC细胞。结果IBSC患者近端空肠黏膜的5-HT含量与健康人相比有统计学意义（122±54ng／mg蛋白比188±91ng／mg蛋白,P〈0．05）,而十二指肠降段和回肠末段黏膜5-HT含量（182±90ng／mg蛋白、61±35ng／mg蛋白）与健康人相比（256±84ng／mg蛋白、93±45ng／mg蛋白）无统计学意义（P〉0．05）。IBS-D患者不同部位小肠黏膜5-HT含量与健康人相比均无统计学意义（P〉0．05）。IBS-C和IBSD患者不同部位小肠黏膜EC细胞数量与健康人相比均无统计学意义（P〉0．05）。结论上述结果提示1BS患者小肠黏膜5HT信号系统异常是其发病机制之-,但是在IBS-C和IBS-D之间有差异。     

136例结肠憩室病的内镜特点及临床分析

目的探讨结肠憩室的内镜及临床特点。方法回顾性分析近9年我院经结肠镜诊断的136例结肠憩室患者的临床资料。结果本组中≥60岁人群中结肠憩室的检出率为62.50%,25～59岁人群中结肠憩室的检出率为36.76%;〈25岁人群中结肠憩室的检出率为0.74%。憩室部位以右半结肠更常见（80.15%）;多发憩室（88/136）较单发憩室（48/136）多见;伴发病中以结肠息肉最多（40.44%）。便秘、腹痛、腹胀、便血为常见临床表现。结论结肠憩室好发于老年人,右半结肠为好发部位,多发较单发常见,容易伴发结肠息肉。结肠镜是诊断本病的最佳方法。     

替加色罗治疗便秘型肠易激综合征的多中心临床研究

目的　通过患者对肠易激综合征 (IBS)症状的总体评估和对每个IBS症状的个别评估以及不良反应观察 ,评估替加色罗 6mg每日 2次治疗便秘型肠易激综合征 (C IBS)的疗效与安全性。方法　本研究是一项多中心、随机、双盲、平行、安慰剂对照临床研究。入选 51 0例符合罗马Ⅱ标准的C IBS患者 ,试验为期 8周 ,包括 2周基线期 ,4周替加色罗 6mg每日 2次或安慰剂 (替加色罗∶安慰剂=1∶1 )随机、双盲治疗期及 2周停药随访期。评估标准 :对患者全部IBS症状进行总体评估 ,对患者每个IBS参数 (包括便秘严重程度 )以及安全性进行评估。结果　替加色罗组患者总体IBS症状的主要疗效参数从第 1周开始至整个治疗期均有显著改善。替加色罗组其他IBS疗效参数 (如便秘、腹痛、腹部不适、腹胀 )评分从第 1周开始至整个治疗期仍均优于安慰剂组。说明替加色罗疗效更明显。在停药随访期 ,替加色罗组和安慰剂组各疗效参数评分虽有所降低 ,但相对于基线期仍均有所改善 ,但前者疗效明显优于后者 ,提示替加色罗的疗效至少可持续到停药后 2周。替加色罗组和安慰剂组发生不良事件的比例分别为 1 0 %和 6 %。替加色罗组最常见的不良事件为腹泻、腹痛和头晕 ,但发生率均较低 (<3 % )。实验室检查未发现异常。结论　替加色罗 6mg每日 2次能