一种新型通便器在直肠粪嵌塞治疗中的应用

Application of a new-type of defecator in the treatment of rectal fecal impaction

目的探讨一种新型通便器在直肠粪嵌塞治疗中应用的可行性和安全性。方法本研究采用描述性病例系列研究方法。本通便器适用于年龄为18~80岁、符合直肠粪嵌塞的诊断标准、经CT检查发现急性直肠粪嵌塞的便秘患者。禁忌证为:(1)肛门狭窄、急性肠梗阻和肠穿孔;(2)合并有直肠恶性肿瘤;(3)合并有凝血功能障碍、血小板降低、消化道出血等出血风险较高疾病的患者;(4)合并有严重心、脑、肺等系统基础疾病;(5)患有精神疾病。根据上述标准,回顾性分析德阳市人民医院于2020年7月至2023年4月期间应用新型通便器治疗的42例直肠粪嵌塞患者的临床资料。通便器由头部、螺旋状杆部和柄部组成,材料为一次性使用的不锈钢丝。治疗操作步骤如下:患者取左侧屈曲卧位,臀略突出于床边,以肛门为中心将透明密封袋固定于臀部。双手从密封袋手套入口处插入,取液体石蜡棉球润滑肛管,通便器头部和杆部螺旋体润滑两次,将通便器缓慢旋转伸入肛内,过程中注意阻力变化,待杆部螺旋体完全进入后,嘱患者吸气后做排便动作同时将螺旋体连同分解的粪团一并缓慢拖出肛外,置于密封袋污物兜。重复操作2~3次后,直肠内注入36℃生理盐水100 ml或液状石蜡60 ml,等待5~8 min后患者取蹲位,排出直肠内残留粪便。观察分析操作时间、单次治疗成功率、治疗疼痛程度和并发症发生情况。结果42例患者应用新型通便器治疗全部获得成功,单次治疗成功率100%,操作时间11.0(9.0~13.3)min,治疗时发生肛门中重度疼痛20例(47.6%),肛裂出血1例(2.4%),治疗过程中出现心慌、冒汗等不适6例(14.3%),所有病例均未出现直肠穿孔等严重并发症。结论新型通便器用于治疗急性直肠粪嵌塞的操作简便,安全可行。

Objective This study aimed to investigate the viability and safety of a novel defecator in managing rectal fecal impaction.Methods In a descriptive case series,this new defecator was administered to constipated individuals among the ages of 18 and 80 years who met the diagnostic criteria for rectal fecal impaction and were identified with acute rectal fecal impaction through CT scans.The contraindications for this defecator included:(1)Anal stenosis,acute intestinal obstruction,and intestinal perforation;(2)Concomitant rectal malignant tumors;(3)Coagulation dysfunction,low platelet counts,gastrointestinal bleeding,or other bleeding risks;(4)Patients with severe underlying conditions affecting the heart,brain,lungs,or other systems;(5)Individuals with mental health disorders.Based on these criteria,clinical data from 42 patients with rectal fecal impaction who underwent treatment with the new defecator at Deyang People's Hospital between July 2020 and April 2023 were retrospectively analyzed.The defecator comprises three components:a head,a spiral rod,and a handle,constructed from disposable stainless steel wire.The treatment procedure involves the following steps:The patient assumes a flexed,supine position on their left side with their buttocks slightly protruding from the bed's edge.A transparent sealing bag is affixed to the buttocks,centered around the anus.With gloved hands inserted through the bag's entrance,a cotton ball soaked in liquid paraffin lubricates the anal canal and the head of the defecator's spiral rod.The defecator is then slowly rotated and inserted into the anus,with careful attention to any changes in resistance.Once the spiral rod is fully inserted,the patient is instructed to inhale and defecate while the defecator is slowly withdrawn,carrying the dislodged fecal matter,and depositing it into the sealed bag.This operation is repeated 2 to 3 times,followed by the injection of either 100 ml of 36°C normal saline or 60 ml of liquid paraffin into the rectum.After a 5 to 8-minute wait,the patient assumes a squatting position to expel any remaining feces from the rectum.The study assessed the operation time,single treatment success rate,pain levels during treatment,and the occurrence of complications.Results All 42 patients successfully underwent treatment with the new defecator device,achieving a single treatment success rate of 100%.The average operation time was 11.0 minutes(range:9.0 to 13.3 minutes).During treatment,20 cases(47.6%)reported moderate to severe anal pain,with 1 case(2.4%)experiencing anal fissure bleeding,and 6 cases(14.3%)reporting discomfort such as palpitations and sweating.No serious complications,including rectal perforation,were observed in any case.Conclusion The new defecator device demonstrates ease of use and safety,making it a feasible option for treating acute rectal fecal impaction.