成人自发性巨直肠的临床特点及其中西医结合治疗的研究
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摘要
目的：探讨成人自发性巨直肠所致便秘的临床相关检查及症状表现的特点,分析经肛门双PPH手术结合针灸疗法对该病的治疗效果。方法：观察伴有和不伴有直肠肠腔扩张的两组便秘患者的症状及临床相关检查,分析其差异,并采用经肛门双PPH手术结合针灸疗法治疗,对比治疗前后主要症状、体征的变化情况。结果：成人自发性巨直肠患者的直肠感觉容量、直肠最大容量增加,直肠顺应性增高(P<0.01),直肠肛管抑制反射减弱或不典型,其症状与其他类型便秘也不尽相同。30例患者经治疗后临床症状较前明显好转,随访3个月,无复发,治疗效果满意。结论：巨直肠是引起便秘的主要原因之一,其发病与长期便秘有着密切关系,并具有其自己的临床特点。经肛门双PPH环切吻合术恢复直肠的正常生理结构,术后配合针灸治疗恢复肠道的生理功能,该疗法充分体现了整体观念和标本兼治的思想,具有显著的微创、高效的优点,为治疗成人自发性巨直肠提供了一种较为理想的治疗方法。
Objective:To inquire into the diagnostic and clinical signify of the Adult Spontaneity Megarectum Constipation and evaluate the effect of the therapy of double PPH and acupuncture. Methods:Observing and analyzing the diagnostic and clinical signify of the patients who with megarectum and who not, contrasting the changes of the symptom and signs before or after the patients treating by double PPH and acupuncture. Results:The patients in Adult Spontaneity Megarectum group shows higher return sensation threshold (P<0.01) and rectal compliance, and has its own clinical characteristic. The clinical symptom of the 30 patients diagnosing for this type constipationafter treating by double PPH and acupuncture improved (P<0.01) and does not have the recrudescence after 3 months. Conclusion:The Adult Spontaneity Megarectum is one of important reasons to cause constipation, and has its own diagnostic and clinical signify. The treatment of double PPH and acupuncture which has fully manifestes the concept of entireentirety and thought of treating the symptoms and the causes together. Provide one more ideal surgery type for the treatment of the adult spontaneity megarectum constipation.
Objective:To inquire into the diagnostic and clinical signify of the Adult Spontaneity Megarectum Constipation and evaluate the effect of the therapy of double PPH and acupuncture. Methods:Observing and analyzing the diagnostic and clinical signify of the patients who with megarectum and who not, contrasting the changes of the symptom and signs before or after the patients treating by double PPH and acupuncture. Results:The patients in Adult Spontaneity Megarectum group shows higher return sensation threshold (P<0.01) and rectal compliance, and has its own clinical characteristic. The clinical symptom of the 30 patients diagnosing for this type constipationafter treating by double PPH and acupuncture improved (P<0.01) and does not have the recrudescence after 3 months. Conclusion:The Adult Spontaneity Megarectum is one of important reasons to cause constipation, and has its own diagnostic and clinical signify. The treatment of double PPH and acupuncture which has fully manifestes the concept of entireentirety and thought of treating the symptoms and the causes together. Provide one more ideal surgery type for the treatment of the adult spontaneity megarectum constipation.
引文
[1]Thompason WG, Longstreth GE, Drossman DA, Heaton KW, Irvine. EJ, Muller-Lissner SA. Functional bowel disorders and functional abdominal pain. Gut.,1999; 45(suppl 2):Ⅱ43-Ⅱ47.
[2]Stewart WF, Liberman JN, Sandier RS, et al. Epidemiology of constipation (EPOC) study in the united states:relation of clinical subtypes to sociodemographic features. Am J Gastroenterol,1999; 94 (12):3530-3540.
[3]戴菲,罗金燕,龚均,等.慢性便秘患者精神心理因素的研究.中国肛肠杂志,2000；2(1)：13-15.
[4]郭晓峰,柯美云,潘国宗,等.北京地区成人慢性便秘整群、分层、随机流行病学调查及相关因素分析.中华消化杂志,2002；22(10)：637.
[5]Julia V, Morteau O, Bueno L, et al. Gastroenterology,1994; 107:94-102.
[5]张东铭,王玉成,阎于悌,等.盆底与肛门病学.贵阳：贵州科技出版社,2000,1：326-327.
[6]Bassotti G. Villanacci V, Maurer CA, et al. The role of glial cells and apoptosis neurones in the neuropathology of intractable slow transit constipation. Gut,2006; 55 (1):41-46.
[7]Gil K,Krolczyk G Kaszuba-Zwoinska J, et al. Vagal chronic stimulation decreased colonic Cajal cells density in rats. Folia Med Cracov.2004; 45(1-2):81-90.
[8]Jung HK,KIm DY, Moon IH, et al.Colonic transit time in diabetic patients-comparison with healthy subject and. the effect of autonomic neuropathy. Yorisei Med J.2003; 44(2):'265-272.
[9]Bassotti G Battaglia E, Bellone G et al. Interstitial cells of Cajal, enteric nerves, and glial cells in colonic diverticular disease. J Clin Pathol.2005; 58(9):973-977.
[10]黄乃健,王玉成,宋光瑞,等.中国肛肠病学.济南：山东科学技术出版社,1996,1：152.
[11]李小松,王燕霞,张金哲.肠神经元发育不良症的诊断和治疗.实用儿科临床杂志.2006；12(6)：674-675.
[12]陈亮,周建华.杨铁峰.分期手术治疗先天性巨结肠1例.中国肛肠病杂志.2001；8(7)：31.
[13]石美鑫,熊汝成,李鸿儒,等.实用外科学.北京：人民卫生出版社,1994,1：665-668.
[14]黄国栋,胡明,郑若,等.特发性巨结肠与成人先天性巨结肠的诊断与鉴别,中国误诊学杂志.2003；9(9)：1414.
[15]楼征,孟荣贵,于恩达,等.成人先天性巨结肠的诊断与外科治疗.中华胃肠外科杂志,2005；8(4)：305.
[16]Longo A. Treatment of hemorrhoids disease by reduce of mucosa and hemorrhiodal prolaps with a circulan suturing device:a new procedure in proceding of the world. Congress Endoscopy Surgery,1998; 6:3-6 Roma,777-784.
[17]周峰.吻合器环切治疗直肠粘膜内套叠所致便秘21例报告.甘肃中医.2002；15(6)：38.
[18]丁克,王本军.经肛门双荷包闭合术治疗直肠前突型便秘(附30例报告).山东医药,2005；45(9)：37-38.
[1]柯美云,罗金燕,许国铭,等.慢性便秘诊治指南.中华消化杂志,2004；24(1)：39-40.
[2]Thompason WG, Longstreth GE, Drossman DA, Heaton KM, Irvine.EJ, Muller—Lissnier SA. Functional bowel disorders and functional abdominal pain.Gut.1999; 45(suppl 2):Ⅱ43-Ⅱ47.
[3]Stewart WF,Liberman JN, Sandier RS, et al. Epidemiology of constipation (EPOC) study in the united states:relation of clinical subtypes to sociodemographic features. M JGastroenterol,1999; 94 (12):3530-3540.
[4]戴菲,罗金燕,龚均,等.慢性便秘患者精神心理因素的研究.中国肛肠杂志,2000；2(1)：13-15.
[5]郭晓峰,柯美云,潘国宗,等.北京地区成人慢性便秘整群、分层、随机流行病 学调查及相关因素分析.中华消化杂志,2002；22(10)：637.
[6]尉秀清,王锦辉.广州市居民肠易激综合症及功能性便秘的流行病学调查.中华内科杂志,2001；40(8)：517-520.
[7]中华消化学会胃肠动力学组.我国慢性便秘的诊治指南.中国全科医学,2005；8(2)：119-121.
[8]Fisher SE, Breckan K, Andrew s HA, et al. Psychiatric screening for patients with faecal incontinence or chronic constipation referred for surgical treatment. Br J Surg,1989; 76(4):352.
[9]Chattat R, Bazzocchi G, Balloni M, et al. Illness behavior,affective disturbance and intestinal transit time in idiopathic constipation. J Psycho som Res,1997; 42(1):95.
[10]Bassotti G.Villanacci V, Maurer CA, et al.The role of glial cells and apoptosis neurones in the neuropathology of intractable slow transitconstipation. Gut,2006; 55(1):41-46.
[11]Gil K, Krolczyk G Kaszuba-Zwoinska J, et al.Vagal chronic stimulation decreased colonic Cajal cells density in rats. Folia Med Cracov.2004; 45(1-2):81-90.
[12]Jung HK, KIm DY, Moon IH, et al. Colonic transit time in diabetic patients-comparison with healthy subject and the effect of autonomic neuropathy. Yonsei Med J.2003; 44(2):265-272.
[13]Bassotti G Battaglia E, Bellone G et al. Interstitial cells of Cajal, enteric nerves, and glial cells in colonic diverticular disease.J Clin Pathol.2005; 58(9):973-977.
[14]Sabri M, Barksdale E, Di Lorenzo C. Dig Dis Sci,2003; 48:849-853.
[15]Lyford GL,He CL, Soffer E, et al. Gut,2002; 51:496-501.
[16]Tomita R,Fujisaki S, Ikeda T,et al. Dis Colon Rectum,2002; 45:593-600.
[17]Faussone-Pellegrini MS, Infantino A, Matini P, el al. Histol Histopathol, 1999; 14:1119-1134.
[18]Cortesini C, Cianchi F, Infantino A, et al. Dig Dis Sci,1995; 40:2450-2455.
[19]Tzavellak, Riepl RL, Klauser AG, et al. Eur J Gastroenterol Hepatal,1996; 8:1207-1211.
[20]Mitolo-Chieppa D,Mansi G, Rinaldi R,et al. Dig Dis Sci,1998; 43: 2719-2726.
[21].Mollenl RM, Hopman WP Kui jpers HH, et al.Plasma cholecystokinin, Plasma peptide YY and gallbladder motility in patients with sfow transit constipation:effect of intestinal stimulation Digestion.2000;62(2-3): 185-193.
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[55]丁克,王本军.经肛门双荷包闭合术治疗直肠前突型便秘(附30例报告).山东医药,2005；45(9)：37-38.
[2]Stewart WF, Liberman JN, Sandier RS, et al. Epidemiology of constipation (EPOC) study in the united states:relation of clinical subtypes to sociodemographic features. Am J Gastroenterol,1999; 94 (12):3530-3540.
[3]戴菲,罗金燕,龚均,等.慢性便秘患者精神心理因素的研究.中国肛肠杂志,2000；2(1)：13-15.
[4]郭晓峰,柯美云,潘国宗,等.北京地区成人慢性便秘整群、分层、随机流行病学调查及相关因素分析.中华消化杂志,2002；22(10)：637.
[5]Julia V, Morteau O, Bueno L, et al. Gastroenterology,1994; 107:94-102.
[5]张东铭,王玉成,阎于悌,等.盆底与肛门病学.贵阳：贵州科技出版社,2000,1：326-327.
[6]Bassotti G. Villanacci V, Maurer CA, et al. The role of glial cells and apoptosis neurones in the neuropathology of intractable slow transit constipation. Gut,2006; 55 (1):41-46.
[7]Gil K,Krolczyk G Kaszuba-Zwoinska J, et al. Vagal chronic stimulation decreased colonic Cajal cells density in rats. Folia Med Cracov.2004; 45(1-2):81-90.
[8]Jung HK,KIm DY, Moon IH, et al.Colonic transit time in diabetic patients-comparison with healthy subject and. the effect of autonomic neuropathy. Yorisei Med J.2003; 44(2):'265-272.
[9]Bassotti G Battaglia E, Bellone G et al. Interstitial cells of Cajal, enteric nerves, and glial cells in colonic diverticular disease. J Clin Pathol.2005; 58(9):973-977.
[10]黄乃健,王玉成,宋光瑞,等.中国肛肠病学.济南：山东科学技术出版社,1996,1：152.
[11]李小松,王燕霞,张金哲.肠神经元发育不良症的诊断和治疗.实用儿科临床杂志.2006；12(6)：674-675.
[12]陈亮,周建华.杨铁峰.分期手术治疗先天性巨结肠1例.中国肛肠病杂志.2001；8(7)：31.
[13]石美鑫,熊汝成,李鸿儒,等.实用外科学.北京：人民卫生出版社,1994,1：665-668.
[14]黄国栋,胡明,郑若,等.特发性巨结肠与成人先天性巨结肠的诊断与鉴别,中国误诊学杂志.2003；9(9)：1414.
[15]楼征,孟荣贵,于恩达,等.成人先天性巨结肠的诊断与外科治疗.中华胃肠外科杂志,2005；8(4)：305.
[16]Longo A. Treatment of hemorrhoids disease by reduce of mucosa and hemorrhiodal prolaps with a circulan suturing device:a new procedure in proceding of the world. Congress Endoscopy Surgery,1998; 6:3-6 Roma,777-784.
[17]周峰.吻合器环切治疗直肠粘膜内套叠所致便秘21例报告.甘肃中医.2002；15(6)：38.
[18]丁克,王本军.经肛门双荷包闭合术治疗直肠前突型便秘(附30例报告).山东医药,2005；45(9)：37-38.
[1]柯美云,罗金燕,许国铭,等.慢性便秘诊治指南.中华消化杂志,2004；24(1)：39-40.
[2]Thompason WG, Longstreth GE, Drossman DA, Heaton KM, Irvine.EJ, Muller—Lissnier SA. Functional bowel disorders and functional abdominal pain.Gut.1999; 45(suppl 2):Ⅱ43-Ⅱ47.
[3]Stewart WF,Liberman JN, Sandier RS, et al. Epidemiology of constipation (EPOC) study in the united states:relation of clinical subtypes to sociodemographic features. M JGastroenterol,1999; 94 (12):3530-3540.
[4]戴菲,罗金燕,龚均,等.慢性便秘患者精神心理因素的研究.中国肛肠杂志,2000；2(1)：13-15.
[5]郭晓峰,柯美云,潘国宗,等.北京地区成人慢性便秘整群、分层、随机流行病 学调查及相关因素分析.中华消化杂志,2002；22(10)：637.
[6]尉秀清,王锦辉.广州市居民肠易激综合症及功能性便秘的流行病学调查.中华内科杂志,2001；40(8)：517-520.
[7]中华消化学会胃肠动力学组.我国慢性便秘的诊治指南.中国全科医学,2005；8(2)：119-121.
[8]Fisher SE, Breckan K, Andrew s HA, et al. Psychiatric screening for patients with faecal incontinence or chronic constipation referred for surgical treatment. Br J Surg,1989; 76(4):352.
[9]Chattat R, Bazzocchi G, Balloni M, et al. Illness behavior,affective disturbance and intestinal transit time in idiopathic constipation. J Psycho som Res,1997; 42(1):95.
[10]Bassotti G.Villanacci V, Maurer CA, et al.The role of glial cells and apoptosis neurones in the neuropathology of intractable slow transitconstipation. Gut,2006; 55(1):41-46.
[11]Gil K, Krolczyk G Kaszuba-Zwoinska J, et al.Vagal chronic stimulation decreased colonic Cajal cells density in rats. Folia Med Cracov.2004; 45(1-2):81-90.
[12]Jung HK, KIm DY, Moon IH, et al. Colonic transit time in diabetic patients-comparison with healthy subject and the effect of autonomic neuropathy. Yonsei Med J.2003; 44(2):265-272.
[13]Bassotti G Battaglia E, Bellone G et al. Interstitial cells of Cajal, enteric nerves, and glial cells in colonic diverticular disease.J Clin Pathol.2005; 58(9):973-977.
[14]Sabri M, Barksdale E, Di Lorenzo C. Dig Dis Sci,2003; 48:849-853.
[15]Lyford GL,He CL, Soffer E, et al. Gut,2002; 51:496-501.
[16]Tomita R,Fujisaki S, Ikeda T,et al. Dis Colon Rectum,2002; 45:593-600.
[17]Faussone-Pellegrini MS, Infantino A, Matini P, el al. Histol Histopathol, 1999; 14:1119-1134.
[18]Cortesini C, Cianchi F, Infantino A, et al. Dig Dis Sci,1995; 40:2450-2455.
[19]Tzavellak, Riepl RL, Klauser AG, et al. Eur J Gastroenterol Hepatal,1996; 8:1207-1211.
[20]Mitolo-Chieppa D,Mansi G, Rinaldi R,et al. Dig Dis Sci,1998; 43: 2719-2726.
[21].Mollenl RM, Hopman WP Kui jpers HH, et al.Plasma cholecystokinin, Plasma peptide YY and gallbladder motility in patients with sfow transit constipation:effect of intestinal stimulation Digestion.2000;62(2-3): 185-193.
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