对ASCRS 2016版《便秘评估与管理临床实践指南》的理解与思考

Understanding and thinking of Clinical Practice Guideline for the Evaluation and Management of Constipation(2016 edition) of the American Society of Colon and Rectal Surgeons

美国结直肠外科医师学会(ASCRS)于2016年发布了《便秘评估与管理临床实践指南》,该指南在2007年发布的《便秘治疗临床实践参考》的基础上进行补充与更新。在便秘的评估方面:强调了病史采集和体格检查的重要性,对肛门直肠生理学检查、结肠传输试验、排粪造影等传统检查项目均给予1类推荐。在便秘保守治疗方面:虽然指南对短期使用刺激性泻药、生物反馈治疗均给予1类证据推荐。但笔者认为对于刺激性泻剂的应用仍应保持审慎态度。在便秘的手术治疗方面:对全结肠切除回肠直肠吻合术给予1类推荐,对次全结肠切除盲肠直肠等各种吻合方式也给予客观的评价;对直肠前突的手术治疗给予1B类推荐。对现有的治疗方法均无效的顽固性便秘病人,永久性肠造口术作为最后的一个选择也给予1类推荐,这一点值得关注。综合来看,该指南侧重于内容的广泛性与包容性,为临床决策提供有用的信息,而不是重在规范具体的治疗方法。

The American Society of colon and rectal surgeons （ASCRS） issued Clinical Practice Guideline for the Evaluation and Management of Constipation in 2016, this guideline is supplemented and updated on the basis of the clinical practiceparameters for treatment of constipation published in 2007. Evaluation of constipation： the importance of medical history collection and physical examination was emphasized. It was 1 types of recommended for the anorectal physiology ,colon transit investigations, defecography and other traditional inspection items. Nonoperative management of constipation： short term use of irritant laxatives and biofeedback therapy was recommended for 1 types of evidence. But for the application of stimulant laxatives ,we still maintain a cautious attitude. Surgical management of constipation：It was 1 types of recommendations for total abdominal colectomy with ileorectal anastomosis （TAC-IRA）. An objective evaluation was also given for the subtotal total colectomy with cecorectal anastomosis and other anastomosis way. Treatment of rectocele surgery was 1B types of recommended. What is worth paying attention to is 1 types of recommendations for permanent colostomy as a final option for patients with intractable constipation who were ineffective in current treatments, In general, the guidelines focus on the universality and inclusiveness of the content, providing useful information for clinical decision-making, rather than focusing on specific treatment methods.