胃肠排空试验联合钡灌肠+排粪造影惯续检查在便秘分型中的应用

Application value of gastrointestinal emptying test combined with barium enema and defecography in the classification of constipation

目的探讨胃肠排空试验联合钡灌肠+排粪造影惯续检查在便秘分型中的应用价值。方法回顾性分析2015年4月至2019年12月在宜宾市第三人民医院进行胃肠排空试验联合钡灌肠+排粪造影惯续检查的95例便秘患者的临床资料,全部患者均先进行胃肠排空试验,于清洁灌肠后再进行钡灌肠+排粪造影检查。按照卢仁华、龚水银的诊断标准与测量指标进行诊断,按照胃肠排空试验检查,分为未见慢传输改变组和慢传输改变组,对比分析两组患者钡灌肠及排粪造影异常改变情况。结果胃肠排空试验发现结肠慢传输改变40例,55例未见慢传输改变;慢传输组经钡灌肠检查发现结肠分布异常共计50种,经排粪造影检查全部提示出口梗阻;结肠未见慢传输组经钡灌肠检查发现结肠分布异常共计52种,经排粪造影检查提示出口梗阻共计26例。结论胃肠排空试验能模拟食物在消化道内运动时间点的位置状态,能动态分析粪便运动的生理过程,能检出是否存在结肠慢传输改变;钡灌肠能为便秘提供结肠形态学改变的直接影像学证据;排粪造影是诊断出口梗阻型便秘的重要方法;三者的结合,并惯续检查,能做到对便秘分型较精准诊断,为临床治疗提供有力依据。

Objective To explore the value of gastrointestinal emptying test combined with barium enema and defecography in the classification of constipation.Methods The clinical data of 95 patients with constipation who underwent gastrointestinal emptying test combined with barium enema and defecography in The Third People's Hospital of Yibin from April 2015 to December 2019 were retrospectively analyzed.All patients underwent gastrointestinal emptying test first,followed by barium enema and defecography after clean enema.The diagnosis was made according to the diagnostic criteria and measurement indicators of LU Ren-hua and GONG Shui-yin.According to gastrointestinal drainage test,the patients were divided into two groups with or without slow transmission change,and the abnormal changes of barium enema and defecography were compared and analyzed.Results Gastrointestinal emptying test showed slow transmission changes in colon in 40 cases,and no slow transmission changes in 55 cases.In the 40 patients with slow transmission changes,barium enema showed 50 kinds of abnormal distribution of colon,and defecography indicated outlet obstruction in all the patients.In the 55 patients with no slow transmission changes,52 kinds of abnormal distribution of colon were found by barium enema,and defecography indicated outlet obstruction in 26 patients.Conclusion Gastrointestinal emptying test can simulate the position and state of food at the time point of movement in the digestive tract,dynamically analyze the physiological process of fecal movement,and detect whether there are changes of slow colon transmission.Barium enema can provide direct imaging evidence of morphological changes of colon for constipation.Defecography is an important method for the diagnosis of outlet obstruction constipation.The combination of the three and the regular continuous examination can make a more accurate diagnosis of constipation,and provide a strong basis for clinical treatment.