生物反馈治疗对出口梗阻型便秘两种亚型的疗效比较

Comparison of biofeedback therapy in treatment of two subtypes of outlet obstructive constipation

目的比较生物反馈治疗对出口梗阻型便秘(OOC)盆底松弛型、盆底失弛缓型两种亚型的疗效。方法选取60例OOC患者为研究对象,其中盆底松弛型便秘患者36例(松弛型组),盆底失弛缓型便秘患者24例(失弛缓型组)。两组患者均予生物反馈治疗2~4周,比较两组治疗前后盆底肌电图测量结果、便秘症状评估结果。结果松弛型组患者治疗后快速收缩平均波幅、持续收缩平均波幅、耐久收缩平均波幅均明显升高(均P<0.05),排便费力、排便不尽、肛门阻塞、肛门坠胀评分均明显下降(均P<0.05);而治疗前后测试前基线、快肌放松时间、测试后基线以及粪便性状、排便频率评分比较,差异均无统计学意义(均P>0.05)。失弛缓型组患者治疗后测试前基线、快肌放松时间、测试后基线以及6项便秘症状评分均明显下降(均P<0.05);而治疗前后快速收缩平均波幅、持续收缩平均波幅、耐久收缩平均波幅比较,差异均无统计学意义(均P>0.05)。比较两组患者盆底肌电图各项指标以及便秘症状评分治疗前后的差值,结果显示松弛型组快速收缩平均波幅的差值大于失弛缓型组(P<0.05),而测试前基线、测试后基线以及排便频率、排便不尽评分的差值均小于失弛缓型组(均P<0.05)。结论生物反馈治疗对OOC盆底松弛型、失弛缓型患者均有明显效果,其中盆底失弛缓型便秘患者更适合生物反馈治疗。

Objective To compare the efficacy of biofeedback therapy for two subtypes of outlet obstructive constipation(OOC).Methods Sixty patients with OOC were enrolled in the study,including 36 patients with relaxed pelvic floor constipation(relaxation group)and 24 patients with dyssynergic defecation(dyssynergia group).The patients in both groups were treated with biofeedback for 2-4 wks,and the results of pelvic floor electromyography and constipation symptoms were compared between the two groups before and after treatment.Results In relaxation group,the average amplitude of rapid contraction,the average amplitude of continuous contraction,the average amplitude of durable contraction increased significantly after treatment(all P<0.05);the scores of straining during defecation,sensation of incomplete evacuation,sensation of blockage and sensation of tenesmus decreased significantly(all P<0.05).But there was no significant difference in baseline before test,relaxative time of fast muscle,baseline after test,the scores of stool consistency and defecation frequency before and after treatment(all P>0.05).In dyssynergia group,the baseline before test,relaxative time of fast muscle,baseline after test and the scores of 6 constipation symptoms decreased significantly after treatment(all P<0.05).But there was no significant difference in the average amplitude of rapid contraction,the average amplitude of continuous contraction,the average amplitude of durable contraction before and after treatment(all P>0.05).To compare of the difference of pelvic floor electromyography and constipation symptom score between the two groups before and after treatment,the results showed that the difference of the average amplitude of rapid contraction in relaxation group was higher than that in dyssynergia group(P<0.05),while the difference of baseline before test,baseline after test,the scores of defecation frequency and sensation of incomplete evacuation were lower than that in dyssynergia group(P<0.05).Conclusion Biofeedback therapy can benefit the patients with relaxed pelvic floor constipation and dyssynergic defecation in OOC,and the patients with dyssynergic defecation are more suitable for biofeedback therapy.