结肠传输试验在慢性功能性便秘分型诊断及治疗中的应用

目的 探讨结肠传输试验在慢性功能性便秘的分型诊断及治疗中的临床意义。方法 回顾性分析2017年6月—2018年9月蚌埠医学院第一附属医院65例慢性功能性便秘患者的临床资料。其中男17例、女48例,年龄14~83(49.8±16.2)岁。患者在正常饮食情况下口服胃肠动力标记物胶囊一枚,于48 h后拍摄腹部立位平片,观察钡环标记物在分段结肠的分布情况,进而明确慢性功能性便秘的分型诊断,并根据分型指导患者治疗。出口梗阻型患者明确有直肠前突及内脱垂者给予吻合器痔上粘膜环形切除钉合术;慢传输型患者给予药物治疗;混合型及正常传输型便秘患者排便训练联合药物治疗。治疗4周后,观察患者的大便性状的Bristol分级、大便频率、排便困难程度评分,评价疗效。结果 65例患者中,慢传输型32例,出口梗阻型13例,混合型2例,结肠传输功能正常者18例。治疗4周后,失访7例。随访58例中,28例慢传输型患者、7例出口梗阻型患者、2例混合型患者及16例正常传输型患者的排便次数、大便性状及排便困难程度均较前改善,治疗有效;另5例无效。结论 结肠传输试验对慢性功能性便秘的分型诊断及治疗具有重要的价值,可为该疾病的临床规范化诊疗方案的制订提供参考。

Clinical study of colonic transmission test in the diagnosis and classification of chronic functional constipation

Objective To observe the clinical significance of colonic transmission test in the classification and treatment of chronic functional constipation.Methods From June 2017 to September 2018, the clinical data of 65 patients with chronic constipation in the First Affiliated Hospital of Bengbu Medical College were analyzed retrospectively. Among them, there were 17 males and 48 females aged 14-83 (49.8±16.2) years.The patients were given an oral gastrointestinal motility marker capsule under the condition of normal diet. Abdominal orthostatic tablets were taken 48 hours later to observe the distribution of barium ring markers in the segmented colon, so as to clarify the classification and guide the treatment of patients according to the classification. The patients with rectocele and prolapse were given circular resection and nailing of stapler and hemorrhoids; the patients with slow transit were given medication; the patients with mixed and normal transit constipation were given defecation training and medication. After 4 weeks of treatment, the stool characteristics, stool frequency and defecation difficulty of the patients were observed to evaluate the efficacy.Results Among 65 patients, 32 were slow transit type, 13 were outlet obstruction type, 2 were mixed type and 18 were normal colon transit function.After 4 weeks of treatment, the defecation frequency, 7 cases were lost and 58 cases were followed up successfully.Stool characteristics and defecation difficulty of 28 patients with slow transmission, 7 patients with outlet obstruction, 2 patients with mixed type and 16 patients with normal transmission were all improved, and the treatment was effective.Conclusions Colonic transmission test is of great value in the classification and treatment of chronic functional constipation, which can provide reference for the standardized clinical diagnosis and treatment of the disease.