摘要:目的: 隨機對照研究、評估生物反饋訓練治療慢性功能性便秘的療效。 方法 : 60例慢性功能性便秘患者,隨機分為治療組30例和對照組30例。治療組接受1個療程(5周)生物反饋訓練治療(10次為一個療程、一次30～45分鐘、每周2次)。對照組患者接受聚乙二醇4000 10g BID 口服,療程5周。治療前后作便秘癥狀評分、結腸通過試驗檢測、直腸肛門壓力檢測。 結果 : 生物反饋訓練和聚乙二醇4000均可使多數慢性功能性便秘患者的大便次數、大便性狀及伴隨癥狀恢復正常或緩解,總有效率分別為667%和80%(P ＞005)。生物反饋訓練和聚乙二醇4000口服治療后,結腸通過試驗72小時標志物排出率分別為75%及73%,均較治療前明顯增加。生物反饋訓練治療后力排時肛門壓明顯下降。 結論 : 生物反饋訓練對出口梗阻型、慢傳輸型便秘均有效,是一種有效的、新興的治療慢性功能性便秘的方法,可作為功能性便秘的一線治療方法。Abstract: Objective: To assess the clinic effect of biofeedback therapy for functional constipation. Methods : Sixty cases of chronic functional constipation were randomly divided into treatment group (30 cases) and control group (30 cases). Cases in the treatment group were exposed to biofeedback for a fiveweeklong treatment course—individual treatment lasted for 3045 minutes and twice per week. Patients in the control group received PEG 4000 10g BID for five weeks. Data from constipation symptom score, colonic transit test, and anorectal manometry were done and compared before and after two kinds of treatments. Results : Biofeedback training and PEG 4000 could restore the stoolfrequency, stool characteristics and accompanying symptoms to normal or mitigation of the majority of patients with chronic functional constipation, with the total effective rates being 667% and 80% (P gt;005), respectively. After biofeedback training and PGE 4000 treatment, the discharge rate of 72hour markers of colonic transit test significantly increased to 75% and 73%, respectively. Additionally, anorectal pressure decreased dramatically after biofeedback training. Conclusion : Biofeedback training would play a positive role in outlet obstruction and slow transit constipation. Thus, it could be an effective firstline treatment of chronic functional constipation.
Objective To summarize the short-term efficacy， surgery complications， and relative experiences in the management of severe functional constipation （SFC） under laparoscopy-assisted subtotal colectomy combined modified Duhamel procedure. Methods All the data of 15 patients underwent laparoscopy-assisted subtotal colectomy combined modified Duhamel procedure from March 2010 to August 2011 were collected retrospectively， all the patients were diagnosed as SFC and failed to conservative therapy. The postoperative short-term efficacy， complications of surgery， score of gastrointestinal living condition， and improvement degree of defecation were analyzed. Results All 15 procedures achieved success， the operation time was （247.33±55.10） min， the intraoperative blood loss volume was （107.33±45.59） ml， the incision length was （8.40±2.41） cm， the postoperative out of bed activity time was （2.27±1.28） d，the postoperative passage of gas by anus time was （2.60±1.89） d， the postoperative defecation time was （2.87±2.50） d，the postoperative foods taken per oral time was （3.07±1.16） d， the hospital stay was （12.64±2.37） d. Approximately on day 3-4 after operation， 10 patients presented with postoperative diarrhea but were all under control with antidiarrheals efficiently. One patient presented with incomplete bowel obstruction on day 8 after operation and one patient with stomal leakage complicated with deep infection on day 9 after operation， who both recovered under conservative therapy. The scoreof gastrointestinal living quality on month 1 after operation was significantly higher than that on day 1 before operation （121.80±4.72 versus 90.80±7.24， P=0.000）， and the improvement degree of defecation was （0.81±0.56）%. Conclusions From the limited case informations， the laparoscopy-assisted subtotal colectomy combined modified Duhamel procedure has a certain short-term curative effect in treatment for SFC with the advantages of faster recovery， less bleeding， shorter hospital stay， and fewer complications.
