功能性便秘与生物反馈治疗

Functional constipation and biofeedback therapy

目的 探讨功能性出口梗阻型便秘及混合型便秘的肛管动力学特点及其生物反馈治疗的意义。方法 36例患者生物反馈治疗 1个月 ,治疗前后进行排便情况、肛管测压、2 4小时GITT以及直肠和盆底肌电描记并进行对比分析。结果 生物反馈治疗后患者每周自主排便次数由治疗前的 (0 .8± 0 .3)次 /周增加到 (4 .1± 1.1)次 /周 ;2 4小时GITT由治疗前的平均 19.4 %增至 6 2 .1% ;功能性出口梗阻及混合型便秘患者经治疗后盆底肌与腹前斜肌的矛盾运动消失 ;便秘组直肠感知阈值、最大耐受量、肛管 直肠抑制反射阈值有所下降。结论 功能性出口梗阻型便秘及混合型便秘均存在肛管 直肠动力异常 ,并有盆底肌与腹前斜肌的矛盾运动 ,治疗后肛管直肠动力异常改善 ,盆底肌与腹前斜肌的矛盾运动消失 ,每周排便次数增加 ,便秘改善。

Objective To investigate the characteristics of anorectal motility in functional outlet obstructive constipation and mixed constipation, and to discuss the significance of biofeedback therapy. Methods 36 cases underwent biofeedback therapy for 1 month, in whom the bowel movement, anorectal manometry, 24h GITT, and pelvic floor electromyography were recorded and compared before and after biofeedback therapy. Results After therapy, the defecation times were increased from (0.8±0.3)time/week to (4.1±1.1)time/week and 24h GITT was increased from 19.4% to 62.1%.The inconsistent movements on pelvic floor muscles and abdominal muscles disappeared in the patients with functional outlet obstructive constipation and mixed constipation. The rectal maximal volume of tolerance and the volume of rectal sensory threshold as well as the anorectal suppressed reflex threshold were decreased after therapy. Conclusion Biofeedback therapy can improve abnormal anorectal motility and inconsistent movements on pelvic floor muscles and abdominal muscles in functional outlet obstructive constipation and mixed constipation patients. The times of defecation are increased and constipation is improved.