生物反馈结合当归芍药散治疗功能性肛门直肠痛30例疗效观察

为探讨生物反馈结合当归芍药散口服治疗功能性肛门直肠痛患者的临床疗效,将中医辨证为血瘀湿滞型的30例功能性肛门直肠痛患者采用生物反馈结合当归芍药散口服治疗,生物反馈每日1次,每次30min;中医治疗采用《金匮要略》当归芍药散方,按照原方比例打粉,每次服40g,每日3次。治疗20d,观察治疗前后疼痛视觉模拟（VAS）评分和症状自评量表（SCL-90）评分。结果显示,治疗后VAS评分躯体化、人际关系、抑郁和焦虑评分明显低于治疗前（P〈0．05）,临床总有效率73．3％。结果表明,生物反馈结合当归芍药散治疗功能性肛门直肠痛安全、有效,而且能够有效改善患者不良情绪,提高其生活质量。     

功能性肛门直肠痛的治疗进展

<正>功能性肛门直肠痛(functional anorectal pain, FAP),是一种发生在肛门直肠区域的反复发作性疾病,是临床常见功能性疾病。其主要临床表现为肛门部的坠胀不适及疼痛,疼痛可放射到腰骶部、臀部等。罗马IV中,将FAP分为非特异性肛门直肠疼痛、肛提肌综合征、痉挛性肛门直肠疼痛^[1]。近年,FAP的患病率逐渐上升,国外一流行病学调查显示,FAP发病率为7.7%,女性较为常见^[2]。FAP的病因及发病机制尚未完全明确,     

生物反馈结合针刺治疗功能性肛门直肠痛40例临床疗效分析

目的 探讨生物反馈结合针刺治疗功能性肛门直肠痛的疗效.方法 根据罗马Ⅲ诊断标准纳入功能性肛门直肠痛病人40例,生物反馈治疗主要根据盆底表面肌电评估结果采用放松训练、Kegel训练及触发电刺激三种模式;针刺主要选取八髂穴(次髂、中髂、下髂)、长强穴,配合神庭、百会等督脉相关穴位.两种治疗方法每日各1次,每次各30 min...     

功能性肛门直肠痛临床特征分析

目的 探讨功能性肛门直肠痛（functional anorectal pain,FARP）临床特征,指导临床诊疗.方法 在罗马Ⅲ诊断标准下回顾性分析46例功能性肛门直肠痛患者的临床资料.结果 46例FARP患者,男女之比1∶ 1.3;平均发病年龄51.43岁;主要表现为坠胀疼痛（56.5%）;15例（32.6%）患者有耻直肌牵拉痛;疼痛视觉模拟评分（VAS）平均为6.52;20例（43.5%）患者伴有其他盆底功能疾病;11例（23.9%）患者接受心理治疗;临床诊断肛提肌综合征15例（32.6%）,非特异性肛门直肠痛18例（39.1%）,痉挛性肛门痛13例（28.3%）;治疗上采用生物反馈结合针刺的方法,总有效率73.9%. 结论 FARP以慢性肛门痛多见,常伴有其他盆底功能障碍疾病和心理问题,生物反馈结合针刺治疗FARP疗效明显     

功能性肛门直肠痛的诊疗现状

功能性肛门直肠痛（functionalanorectalpain，FAP）是一组发生在肛门和（或）直肠的非器质性多发病，以疼痛或坠胀不适为主，可伴里急后重、便意频数等，易反复发作，严重影响患者的生活质量。目前FAP病因病机不明，临床无特定的治疗措施，只能进行探索性的对症治疗。     

重建直肠角肛门成形术治疗肛门直肠闭锁

１９８６年,高春芳首先将重建直肠角式人工肛门应用于直肠癌根治术中［１］,术后肛门功能恢复满意。受此启发,１９８８～１９９６年,我们采用重建直肠角、经腹会阴一期肛门成形术,治疗高位先天性肛门直肠闭锁伴阴道、尿道及舟状窝瘘５８例。术后随访２～８年,其排便功能满意。本文介绍该手术方式并总结５８例的治疗体会。１　临床资料本组新生儿２０例,１岁１５例,３岁１０例,６岁８例,１２岁５例。男３２例,女２６例。根据Ｘ线检查及手术所见,按肛门直肠畸形国际分类标准［２］,本组５８例直肠盲端均在耻骨尾骨线（ＰＣ线）…     

肛肠外科 功能性便秘肛门直肠动力学研究

功能性便秘是功能性肠病的一种,表现为持续的排便困难、便次减少、粪便干结且量少、排便不尽感等症状,且不符合肠易激综合征的诊断标准[1].一般认为有三种类型,即慢传输型、出口梗阻型及混合型.肛门直肠动力学研究内容涵盖了肛门直肠的运动功能及盆底肌协调性运动等方面,通常与伴有出口梗阻的功能性便秘关系密切.     

中西医结合保存括约肌治疗肛门直肠周围脓肿的临床研究

以中西医结合保存括约肌的方法治疗肛门直肠周围脓肿２１例。并对患者术后的肛门外括约肌肌电图、肛管直肠内压、直肠感觉功能、肛门液体节制功能进行了检测。证明本法治疗肛门直肠周围脓肿根治率高，较好地保护了肛门括约肌。     

功能性肛门直肠痛的诊治

罗马Ⅲ中把功能性肛门直肠痛[1](functional anorectal pain,FAP)分为慢性肛门痛(ChroniC proctalgia)和痉挛性肛门痛(proctalgia fugax,PF),两种类型常同时存在,但可根据疼痛持续时间、频率和特征加以区分.其中慢性肛门痛有两种亚型:肛提肌综合征(levator ani syndrome,LAS)和非特异性功能性肛门直肠痛.本文主要讨论上述罗马Ⅲ中所定义的FAP.     

盆底表面肌电生物反馈配合心理认知疗法治疗功能性便秘疗效观察

为观察盆底表面肌电生物反馈配合心理认知疗法治疗功能性便秘的临床疗效,将符合功能性便秘诊断标准的30例患者在治疗前及治疗2个疗程后评定症状及SCL-90量表中的积分,进行对比分析。结果显示,功能性便秘患者治疗前后排便费力、排便不尽感、排便时间及SCL-90量表中抑郁、强迫及偏执因子的积分均有不同程度的改善。结果表明,盆底表面肌电生物反馈配合心理认知治疗功能性便秘疗效肯定。     

我国先天性肛门直肠畸形外科治疗理念的更新与进步

先天性肛门直肠畸形是小儿最常见的结直肠疾病之一。外科肛门成形术是挽救患儿生命的唯一手段。由于肛门直肠畸形常合并盆底或肛周神经肌肉发育缺陷．往往导致术后排粪功能障碍．术后远期生活质量低下给患儿、家庭和社会带来负担。随着现代医学的发展．重视外科解剖重建后的肛门功能重建．开展有针对性的生物反馈训练以改善患儿的排粪功能和远期生活质量．是我国小儿外科肛肠畸形治疗理念的进步和重要更新。先天性肛门直肠畸形新的预防与治疗方法仍在不断探索中。     

High post-operative pain scores despite multimodal analgesia in ambulatory anorectal surgery: a prospective cohort study

Background: Ambulatory surgery for anorectal procedures has become widely accepted. Recent reviews recommend a multimodal approach to pain management. However, these recommendations are largely based on single intervention studies. Our goal was to evaluate post-operative pain in patients receiving a multimodal analgesic regimen.

Methods: All patients undergoing an ambulatory anorectal procedure between December 2015 and September 2016 received a pain diary. Mean pain throughout the day and pain during defecation where recorded on day 0–14 and day 21 postoperatively using a numeric rating scale-11. Use of oral analgesics was also recorded.

Results: Forty-two patients completed the pain diary. The use of local anesthetic infiltration did not result in a significant difference in pain scores in this study. Patients who received written information on postoperative pain management and hygienic measures had higher intake of oral analgesics. Despite receiving multimodal analgesic treatment, patients undergoing surgery for hemorrhoids or anal fissures reported pain scores ≥4 and used analgesics longer.

Conclusion: A multimodal analgesic approach consisting of local anesthetic infiltration, multiple oral analgesics and written information seems to be insufficient for certain patient groups after ambulatory anorectal surgery. Especially patients undergoing surgery for hemorrhoids or an anal fissure should receive adequate analgesia. Pain during defecation is problematic and finding a solution for this problem remains challenging. Further research into the combined use of different analgesic modalities is recommended.     

腹腔镜诊断治疗慢性盆腔痛92例临床分析

目的:通过腹腔镜探查,探讨慢性盆腔痛的各种常见病因及其临床特征和治疗方法。方法:对2000年1月至2004年7月收治的92例慢性盆腔痛患者进行回顾性分析。结果:慢性盆腔痛常见病因有:子宫内膜异位症、子宫腺肌病、盆腔粘连、慢性盆腔炎、盆腔淤血综合征等。结论:慢性盆腔痛病因复杂,腹腔镜为妇科慢性盆腔痛的诊断提供有利的证据,同时还可进行有效的治疗。     

Relationship between psychological factors and performance-based and self-reported disability in chronic low back pain

Cross sectional study, performed in an outpatient university based pain rehabilitation setting. To analyze the relationship between psychological factors (psychosocial distress, depression, self efficacy, self-esteem, fear of movement, pain cognitions and coping reactions) and performance-based and self-reported disability, as measured with a Functional Capacity Evaluation (FCE) and the Roland Morris Disability Questionnaire (RMDQ), in patients with chronic low back pain (CLBP). It has been suggested that a strong relationship exists between psychological factors and disability in patients with CLBP. In former research disability was often measured by self-report and seldom performance-based. Study sample consisted of 92 patients with CLBP admitted for multidisciplinary rehabilitation. Prior to treatment, all patients completed questionnaires to measure psychological factors and self-reported disability, and performed an FCE to measure performance-based disability. Correlation coefficients between psychological variables and FCE and self-reported disability were calculated. Multivariate linear regression analyses were performed with self-reported or performance based disability measures as outcome variables, and psychological measures as predictor variables. Out of 42 relations analyzed, 5 were statistically significant. This concerned one significant correlation between kinesiophobia and a subtest of FCE, and four correlations between psychological factors and RMDQ. No correlation was significant after the Bonferroni correction was applied (P < 0.001). The strength of significant correlations ranged from r = −0.33 to r = 0.25. The multivariate analysis revealed that psychological variables measured in this study could explain 19% of the variance of self-reported disability, with kinesiophobia being the only psychological variable that contributed significantly. The suggested strong relationship between psychological factors and performance-based and self-reported disability could not be confirmed in this study. This may implicate that the relationship between psychological factors and disability in patients with CLBP is not as unambiguous as suggested.     

Chronic pain: psychological formulation and MDT working

Chronic pain is complex and often a challenge to manage. Patients’ expectations are frequently at odds with the treatment outcomes which can be a significant source of distress. Pain is best understood within the biopsychosocial model. Clinical psychologists work as part of the multidisciplinary pain team to draw together information and develop an understanding of how to support patients to live well while experiencing ongoing pain. This article presents two alternative models for formulating and providing therapy for individuals experiencing chronic pain; cognitive behaviour therapy and acceptance and commitment therapy. Psychologically informed strategies to support healthcare professionals in their interactions with people with chronic pain are presented.     

盆底肌功能失调型便秘的生物反馈治疗及护理

目的:探讨盆底功能失调型便秘生物反馈治疗及护理疗效.方法:总结30例盆底功能失调型便秘的生物反馈治疗及护理资料.结果:24例肛管直肠压力测定示直肠感觉阈值,最大耐受容量,直肠肛门抑制反射较治疗前降低,盆底肌的反常收缩消失,恢复正常排便;4例排便次数,排便不尽感,肛门坠胀感较治疗前有所改善,有效率为93.33%,2例无效.结论:盆底肌功能失调型便秘的生物反馈治疗配合相应护理得当近期疗效满意,它具有相对非侵入性,易忍受,费用低,无需住院等优点,其远期疗效值有待于进一步观察.