顽固性功能性便秘的外科治疗进展

近年来我国便秘患者数量呈现逐年增长趋势,其中功能性便秘较为常见,又分为出口梗阻型便秘(OOC)、慢传输型便秘(STC)及混合性便秘(MC)。国内外学者将难以通过保守治疗获得症状缓解的功能性便秘称为顽固性功能性便秘。对于此类患者,在长期无效的内科治疗下有增加肿瘤发生、诱发心脑血管意外及产生严重心理问题的风险。外科手术是顽固性便秘治疗的最后选择。外科学者从未停止对便秘术式的改进,PPH-STARR、TST-STARR、金陵术等术式均有较佳疗效的报道。然而便秘的外科治疗仍然面临引发机制不明确、缺乏预判疗效的方法以及缺乏远期疗效的研究结果等问题。本综述首先阐述顽固性便秘的流行病学、治疗现况及诊断分类标准,并系统性回顾了便秘手术指征、手术方式的选择、手术效果的评估、术后并发症及当前外科治疗存在的问题,以期为了解便秘的外科治疗进展提供便利。     

四磨汤口服液治疗婴幼儿功能性便秘临床观察

目的 观察四磨汤口服液治疗婴幼儿功能性便秘的疗效.方法 将我院80例功能性便秘患儿随机分为治疗组及对照组,对照组患儿采用调整饮食、液体石蜡、开塞露等对症治疗,治疗组在对照组基础上加用四磨汤口服液.结果 经过治疗,治疗组的总有效率为92.5%,显著高于对照组的82.5%,差异有统计学意义(P＜0.05),两组在治疗过程中均未见明显的毒副作用.结论 采用四磨汤治疗婴幼儿功能性便秘有良好疗效,用药方便,无毒副作用,患儿痛苦小、依从性好,值得推广应用.     

出口梗阻性便秘的治疗

出口梗阻性便秘是指排便出口处器官、组织的功能性改变而造成的排便困难的一种胃肠道功能性疾病。近年来针对出口梗阻性便秘治疗的研究不断被业内学者报道,本文将在出口梗阻性便秘的诊断、非手术治疗和手术治疗方面的近年研究进行综述,为提高出口梗阻性便秘治疗水平,规范治疗原则提供参考。     

2.100 胃肠起搏与慢性功能性便秘的治疗

目的应用体外胃肠电起搏仪对便秘患者进行治疗,初步分析了胃肠起搏刺激与功能性便秘的治疗. 方法使用泰士WCH型胃肠起搏器,对26例慢性功能性便秘的患者进行治疗.双电极部位采用标准位置.胃肠电刺激治疗每日一次,每次30分钟,10次为一疗程.     

2.74不同类型功能性便秘的心理状态研究

目的旨在探讨功能性便秘及其不同亚型与心理障碍关系. 方法1.对全部功能性便秘患者进行结肠通过时间测定(Colonic transit test,CTT),参照AGA诊断标准,将FC分为正常通过型便秘(NTC)、慢通过型便秘(STC)、混合型便秘(MC)及出口梗阻性便秘(OOC)4组,对结肠通过时间检查和临床表现可疑出口梗阻性便秘的患者进行了肛直肠测压和排粪造影检查.     

莫沙比利联合乳果糖治疗功能性便秘疗效观察

目的 评价莫沙比利联合乳果糖治疗功能性便秘疗效.方法 84例功能性便秘患者随机分为三组,每组28例.A组给予口服莫沙比利5mg/次,3次/d,乳果糖10ml/次,3次/d;B组单用莫沙比利;C组单用乳果糖.疗程均为4周.记录病人服药前后大便间隔天数、大便性状的改变、排便困难程度改变及副反应.结果 治疗4周后,三组有效率分别为96.4%、46.4%和85.7%.结论 莫沙比利联合乳果糖治疗功能性便秘疗效优于两药单用.     

聚乙二醇4000治疗成人慢性功能性便秘的多中心随机对照临床试验

聚乙二醇4000治疗成人慢性功能性便秘的多中心随机对照临床试验     

针刺治疗慢传输型功能性便秘的临床研究

目的　研究针刺合谷、曲池、大肠俞、天枢、中脘对慢传输型功能性便秘的确切临床疗效及其机理。方法　选取 4 5例慢传输型功能性便秘患者 ,分为三组 :针刺治疗组、生物反馈治疗组和针刺联合生物反馈治疗组 ,从患者的自觉症状、体征 (如粪便量、及硬度等 )、助排方法的使用 (如泄剂或灌肠等 )、结肠传输时间、直肠肛管压力检查和胃电图、核素扫描胃排空试验等多角度研究。结果　针刺疗法治疗慢传输型功能性便秘的有效率为 5 3 3% ,针刺联合生物反馈治疗组的有效率为 6 6 7% ;针刺疗法可以明显改善慢传输型功能性便秘患者的排便困难、粪便太…     

2.90功能性便秘和IBS便秘型在肛管直肠运动和感觉上的异同

目的观察不同的慢性便秘患者在肛管直肠运动、扩张时的直肠感觉上有无异同. 方法根据RomeⅡ诊断标准选择16例功能性便秘(FC)和22例IBS便秘型(IBS-C),均了解患者便秘的相关症状,运用液体灌注测压系统测量直肠、肛管静息压,肛管松弛率等指标,利用电子恒压器检测直肠敏感性及顺应性.     

2.128 生物反馈治疗慢性顽固性功能性便秘的临床研究

目的评价生物反馈治疗各种类型慢性顽固性功能性便秘和疗效及其作用机理.方法选择40例慢性顽固性功能性便秘病人(诊断标准与疗效判定标准遵循19 99年全国便秘学术研讨会制定的标准),其中慢传输型3例,出口梗阻型31例,慢传输与出口梗阻混合型2例,肠易激综合症型4例.所有入组病人发病时间皆超过2年,都经过一般正规的保守治疗,有4例还经过手术治疗,治疗无效.40例病人皆进行了一个疗程的生物反馈治疗(2次/周,共10周),治疗方式有两种肌电图介导和压力介导的生物反馈.治疗前后以及治疗期间所有病人要在医生的指导下填写症状问卷表、治疗日记、心理症状自评表(SCL-90 ).所有病人在治疗结束后都进行了至少一年的随访(随访方式为电话与门诊相结合).数据统计采用x2检验方法(使用SAS10.0软件包).结果所有40例病人皆为自愿入组,其中大部分病人为女性.每个病人都接受了一个疗程的物生反馈治疗.生物反馈疗法可以明显改善便秘病人的排便困难、粪便太硬等症状,可以明显减少便秘病人口服泻药和灌肠的次数,其总有效率为62.5%;出口梗阻型便秘患者的肛管直肠压力在行生物反馈治疗前后变化,结果经统计学处理无显著性差异;在本研究中,生物反馈疗法的成功与否与病人的一般状况(如年龄、性别等)、便秘分型和生物反馈的方式等均无关,唯一的影响因素是病人心理状态,心理状况高症状组的病人接受治疗失败的比率明显升高(P＜0.05);出口梗阻型便秘病人接受生物反馈治疗的成功率明显升高(P＜0.01).Hopkins心理症状自评量表结果显示总分由治疗前42.80±31.27减少为治疗后24.05±20.62(P＜0.01);所有行生物反馈治疗的病人在治疗过程中无1 例出现副作用.结论本研究充分证明生物反馈疗法是一种治疗慢性顽固性功能性便秘的行之有效、而且有确切长期疗效、无副作用的方法,值得在临床上广泛推广.     

不同型别的功能性便秘患儿肛门直肠测压对照研究

目的探讨功能性便秘（FC）患儿与健康儿童肛门直肠动力学差异,为其临床分型诊断及治疗提供依据。方法采用功能性胃肠病罗马Ⅲ诊断标准,收集2008年1月至2009年1月在第四军医大学唐都医院儿科门诊及住院的FC患儿为FC组。选取同期无消化系统症状,平日排便正常的健康儿童为正常对照组。采用不透光X线硫酸钡条测定结肠传输指数（TI）,依据TI将FC组分为出口梗阻型（OOC）亚组、慢传输型（STC）亚组和混合型（MIX）亚组。通过肛门直肠测压法分析FC各亚组与正常对照组肛门直肠动力学差异。结果研究期间FC组纳入25例,其中STC亚组10例,OOC亚组15例,未发现MIX患儿;正常对照组纳入10名。FC组与正常对照组肛门括约肌静息压差异无统计学意义（P〉0.05）。STC亚组肛门括约肌最大收缩压与正常对照组差异无统计学意义（P〉0.05）,OOC亚组肛门括约肌最大收缩压显著高于正常对照组及STC亚组（P〈0.05）。FC组直肠最低敏感量及最大耐受量均显著高于正常对照组（P均〈0.05）。STC亚组与OOC亚组直肠最低敏感量及最大耐受量差异均无统计学意义（P均〉0.05）。结论FC患儿存在明显的肛门直肠动力和感觉异常;OOC和STC患儿的肛门直肠动力学存在差异。肛门直肠测压检查对协助诊断FC有一定价值。     

Prevalence,Clinical Characteristics,and Management of Functional Constipation at Pediatric Gastroenterology Clinics

The purpose of this study was to investigate the prevalence, clinical characteristics, and management of functional constipation at pediatric gastroenterology clinics. A prospective survey using the Rome III criteria was distributed to a group of parents of children with a constipation history and its control group in May 2008. The mean prevalence of constipation was 6.4%, which was similar to those in other countries. Statistically significant variables for children without constipation were that more children had a body mass index of below the 10th percentile even though they received more mother''s care and ate balanced meals compared to the constipation group. Meanwhile, the constipation group frequently showed a history of constipation in infancy, picky-eating, lack of exercise, and retentive posturing. When analyzed with the Rome III criteria, the children showed greater than 60% rate of hard stools, painful stools, a history of large fecal mass in rectum, and its disappearance of constipation symptoms after passing a large stool. Our study found different approaches amongst pediatric gastroenterologists like rectal examinations, disimpaction, or drug treatment. Several factors addressed in our study can provide better guidelines for clinicians treating constipation and its future research.     

小麦纤维素治疗妊娠晚期妇女功能性便秘的30例疗效观察

目的观察小麦纤维素（商品名：非比麸）治疗妊娠晚期合并功能性便秘患者的疗效及安全性。方法采用自身前后对照的前瞻性研究方法,按标准入选30例妊娠晚期合并功能性便秘的患者,给予连续口服小麦纤维素治疗2周,记录服药前后便秘症状和大便性状的变化情况,并进行评分,比较疗效。结果受试患者口服小麦纤维素治疗后,排便困难、排便不尽感、粪便性状和排便的频率均有明显改善,与治疗前比较差异有统计学意义（P〈0.05）,总有效率为90%（27/30）,服药期间未发现明显的不良反应。结论小麦纤维素治疗妊娠晚期合并功能性便秘妇女疗效安全、有效。     

肛直肠肌功能生物反馈治疗系统的研制

介绍一种用于功能性便秘治疗的肛直肠肌功能生物反馈系统的研制.该系统具有高性能的肌电放大器,良好的电气隔离保护,并采用了即插即用、方便快捷的USB接口同PC机相连接,实现数据的采集、存储和显示,该系统将肛门括约肌的活动信息反馈给便秘患者,指导其进行自我调节,从而起到治疗效果.实验结果证实,该治疗系统对于"肛门痉挛"引起的出口梗阻性便秘具有较好的疗效.     

Constipation — a simple approach to treatment

A simple method of treating patients with constipation is outlined and has been used successfully in 40 patients with severe primary constipation or constipation associated with diverticular disease.     

Behavioral medicine approaches to gastrointestinal disorders.

Behavioral research in gastroenterology has grown exponentially over the last decade. Controlled studies demonstrate that psychotherapy, stress management, and hypnosis are effective for irritable bowel syndrome; and behavioral treatments are preferred over medical management for some types of fecal incontinence and vomiting. For peptic ulcer disease, interest in behavioral treatments has declined. However, a new syndrome, functional dyspepsia, is now recognized, in which ulcerlike symptoms occur without ulcer and frequently in association with psychological symptoms. For inflammatory bowel disease, stress management training has produced inconsistent outcomes. Newly recognized disorders for which behavioral treatments are needed include constipation associated with inability to relax the pelvic floor muscles during defecation, functional rectal pain (proctalgia), noncardiac chest pain, and aerophagia (excessive air swallowing).     

Severe juvenile chronic constipation

Constipation in the paediatric population is common and encompasses a spectrum of organic and functional pathology which differ from that of the adult population. Recently an expert group published a comprehensive system of classification of childhood functional gastrointestinal disorders that may have useful clinical application. We present the case of an adolescent schoolgirl with severe constipation with extreme anorectal, urological and neurological sequelae who displayed inappropriate behavioral response to her condition. The patient appeared inappropriately unmotivated and undisturbed by the severity of her constipation. This abnormal psychological habituation and adaptation to an abnormal bowel habit perpetuated the constipation. In addition, we examined the role of recent advances in anorectal investigation techniques and treatment in the context of the recent guidelines issued by the American Gastroenterological Association     

Therapiestrategien der chronischen Obstipation im Kindesalter

Chronic constipation in childhood results from (1) psychological/behavioural causes, (2) functional or organic gastrointestinal outlet obstruction, or (3) slowing of transit within the colon. Functional chronic constipation is treated by a complex conservative bowel management. Constipation refractory to routine medical treatment reveals, in a significant number of cases, organic causes. Histology of bowel biopsies is essential for the preoperative diagnosis of chronic constipation. Defective innervated bowel segments require surgical treatment. Intraoperative histological staining of bowel biopsies allows proper resection of aganglionic or dysganglionic bowel. This contribution describes the interdisciplinary, clinicopathological interactions involving children with chronic constipation.     

结肠传输试验在慢性功能性便秘分型诊断及治疗中的应用

目的 探讨结肠传输试验在慢性功能性便秘的分型诊断及治疗中的临床意义。方法 回顾性分析2017年6月—2018年9月蚌埠医学院第一附属医院65例慢性功能性便秘患者的临床资料。其中男17例、女48例,年龄14~83(49.8±16.2)岁。患者在正常饮食情况下口服胃肠动力标记物胶囊一枚,于48 h后拍摄腹部立位平片,观察钡环标记物在分段结肠的分布情况,进而明确慢性功能性便秘的分型诊断,并根据分型指导患者治疗。出口梗阻型患者明确有直肠前突及内脱垂者给予吻合器痔上粘膜环形切除钉合术;慢传输型患者给予药物治疗;混合型及正常传输型便秘患者排便训练联合药物治疗。治疗4周后,观察患者的大便性状的Bristol分级、大便频率、排便困难程度评分,评价疗效。结果 65例患者中,慢传输型32例,出口梗阻型13例,混合型2例,结肠传输功能正常者18例。治疗4周后,失访7例。随访58例中,28例慢传输型患者、7例出口梗阻型患者、2例混合型患者及16例正常传输型患者的排便次数、大便性状及排便困难程度均较前改善,治疗有效;另5例无效。结论 结肠传输试验对慢性功能性便秘的分型诊断及治疗具有重要的价值,可为该疾病的临床规范化诊疗方案的制订提供参考。     

Adult constipation: a review and clinical guide

Constipation is a common complaint that can be a symptom of serious disease. Awareness of the potential etiologies can help direct the history, physical exam and subsequent work-up for the presenting individual. This article details the differential diagnosis and pathophysiology of constipation based on a review of the literature. The article is also designed to be useful as a guide to the work-up of constipation. Key elements of the history, physical exam and testing are outlined. Included is a detailed flow diagram to guide the work-up of constipation. Testing methods and their value in the evaluation of chronic idiopathic constipation are discussed. Finally, although the focus of this article is the evaluation of constipation, a section on the treatment of constipation is included.