1890例慢性便秘患者的消化道传输特征分析

Analysis of transmission characteristics of digestive tracts in 1890 patients with chronic constipation

目的通过少量钡餐（SAB）法胃肠传输试验，观察并分析慢性便秘患者的消化道传输特征。方法回顾性分析2009年1月至2015年3月间郑州大学第一附属医院肛肠外科符合罗马Ⅲ诊断标准并接受SAB法胃肠传输试验的1890例慢性便秘患者的影像学资料。所有患者检查前均随粥服下20g医用硫酸钡，分别在餐后4、8、12、24h及之后每间隔24h接受立位腹部X线检查。根据预设标准，评估全消化道及各节段（胃、小肠、右半结肠、左半结肠和直肠）的传输特征。结果全组患者对检查的依从性良好，均按计划完成检查。结果显示，1890例患者中，传输功能正常者794例（42％），传输缓慢者1096例（58％）。按传输缓慢的发生部位划分，胃传输缓慢者151例（8％），小肠传输缓慢者175例（9％），右半结肠传输缓慢者986例（52％），左半结肠传输缓慢者1039例（55％）及直肠传输缓慢（出口梗阻）者139例（7％）。1096例消化道慢传输患者中，多节段型和单节段型传输缓慢者分别为907例（83％）和189例（17％）。907例多节段型传输缓慢者中，668例（74％）为全结肠慢传输，61例（7％）为结肠慢传输并出口梗阻，138例（15％）为小肠结肠慢传输型，40例（4％）为全节段慢传输。189例单节段型传输缓慢者中，17例（9％）为单纯胃传输缓慢，37例（20％）为单纯小肠传输缓慢，19例（10％）为单纯右半结肠传输缓慢，78例（41％）为单纯左半结肠传输缓慢，38例（20％）为单纯出口梗阻。结论慢性便秘患者的消化道传输特征各异，多数表现为合并结肠传输缓慢的多节段慢传输。SAB法胃肠传输试验有助于慢性便秘患者消化道传输特征的分段评估。值得临床推广应用。

Objective To investigate the characteristics of gastrointestinal transit in chronic constipation patients depending on a small amount barium （SAB） gastrointestinal transit test. Methods Imaging data of 1890 cases with chronic constipation diagnosed with Rome Ⅲ criteria undergoing the SAB gastrointestinal transit test at Department of Colorectal Surgery, The First Affiliated Hospital of Zhengzhou University from January 2009 to March 2015 were retrospectively analyzed. All the patients took 20 g medical barium sulfate diluted in porridge and erect position abdominal X-ray photographs were then taken at 4, 8, 12, 24 hours after meal and once in every 24 hour sequentially. Transit characteristics of whole gut and various segments, including stomach, small intestine, right hemicolon, left hemicolon and rectum were assessed according to the predetermined criteria. Results All the 1890 patients showed good compliance with the complete test. Among these patients, 794 cases （42%） were diagnosed as normal transit and 1096 cases（58%） as gastrointestinal slow transit. Classified by the site of slow transit, 151 cases （8%） were abnormal gastric transit, 175 （9%） cases were abnormal small intestinal transit, 986 （52%） cases were slow right hemicolon transit, 1039 cases （55%） were slow left hemicolon transit, 139 cases （7%） were outlet obstruction. Among the 1096 patients with slow gut transit, 907 cases（83%） were multiple segments slow transit and 189 cases （17%） were single segment slow transit. Among 907 patients with multiple segmental slow transit, 668 cases （74%） were total colon slow transit, 61 cases （7%） were colonic slow transit combined with outlet obstruction, 138 cases （15%） were small intestine slow transit coincided with colon slow transit, 40 cases （4%） were total segments slow transit in the whole gut. Of 189 cases of single segment slow transit, 17 cases（9%） were unique gastric delayed empting, 37 cases （20%） were unitary small intestine transit dysfunction, 19 cases （10%） were right hemicolon transit defect, 78 cases （41%） were left hemicolon transit deterioration, 38 cases （20%） were outlet obstruction. Conclusions The characteristics of gastrointestinal transit test in patients with chronic constipation varied from each other. Majority presents multi-segment slow transit combined with colon slow transit. SAB gastrointestinal transit test is helpful for surveying the transit characteristics of each segment of gut and worth clinical generalization and application.