《2017版便秘的分度与临床策略专家共识》与《便秘外科诊治指南》联合解读

Joint interpretation of 2017 edition of expert consensus on classification and clinical strategy of constipation and guide for surgical diagnosis and treatment of constipation(2017 edition)

《2017版便秘的分度与临床策略专家共识》于2018年3月发布,将其与《便秘外科诊治指南》(2017版)进行联合解读,发现两者的异同点主要包括:(1)对于便秘的概念,两者的阐述基本一致,主要区别在于“共识”提出了便秘与精神心理障碍的相关性;(2)在便秘的病因、检查方法及评估方面,“共识”未述及病因,检查方法方面两者完全一致,“共识”中增加了精神心理评估的参考标准;(3)对于便秘的诊断,“指南”明确了便秘的诊断标准及分型,仅简单提及便秘的分度,而“共识”就将便秘的三个不同程度加以进一步的细化区分,并着重强调了便秘分度的重要性;(4)在便秘的治疗方面,两者的基本原则相同。在具体治疗方案的描述上,“指南”将便秘的治疗方法分为非手术治疗和外科治疗两大类,再着重阐述外科治疗方式的适宜性和具体操作,而“共识”更多着重于针对不同程度便秘的应对策略及治疗方案的选择,重点在于直面便秘诊疗行为中不可回避的精神心理障碍问题。由此可见,《便秘的分度与临床策略专家共识》是对《便秘外科诊治指南》的补充和完善,从不同的角度为临床提供更有针对性和适用性的临床参考思路,尤其是在便秘分度标准的量化以后更好辅助临床决策。

The 2017 edition of expert consensus on classification and clinical strategy of constipation was released in March 2018.This artide makes a joint interpretation of it with the Guideline for surgical diagnosis and treatment of constipation(2017 edition).The similarities and differences between the two mainly include:(1)The concept of constipation is basically the same,the main difference is that the consensus puts forward the association between constipation and mental disorders.(2)For constipation in terms of etiology,examination methods and evaluation,the consensus does not mention the etiology,but the examination methods are completely consistent.The reference standard of mental and psychological assessment is added in the consensus.(3)For the diagnosis of constipation,the diagnostic criteria and classification of constipation are specified in the guideline,and only the classification of constipation is mentioned briefly,while the consensus further develops the three different degrees of constipation.(4)For the treatment of constipation,the basic principles are the same.In the description of the specific treatment plan,the guideline divides the treatment methods of constipation into two categories:non⁃surgical treatment and surgical treatment,and then focuses on the suitability and specific operation of surgical treatment,while the consensus focuses more on coping strategies and treatment options for different degrees of constipation,including how to deal with the unavoidable mental and psychological disorders in the diagnosis and treatment of constipation questions.It can be seen that the consensus is a supplement and improvement of the guideline for surgical diagnosis and treatment of constipation.The consensus provides more targeted and applicable clinical reference ideas for clinical practice from different perspectives,especially the better auxiliary clinical decision⁃making after the quantification of the classification standard of constipation.