以胸膝卧位提肛锻炼为主的综合保守治疗在直肠内脱垂导致的出口梗阻型便秘患者中的疗效观察  

Effect of comprehensive conservative treatment primarily encompassing anal sphincter exercises at knee-chest position for treating outlet obstruction constipation due to internal rectal prolapse

作　　者：谢兴杰 童卫东 李凡 王李 黄彬 田跃 郑恢超 Xie Xingjie;Tong Weidong;Li Fan;Wang Li;Huang Bin;Tian Yue;Zheng Huichao(Department of General Surgery,Daping Hospital—Army Medical Center,Army Medical University,Chongqing 400042,China)

机构地区：[1]陆军军医大学大坪医院(陆军特色医学中心)普通外科,重庆400042

出　　处：《结直肠肛门外科》2022年第6期563-567,共5页Journal of Colorectal & Anal Surgery

基　　金：国家自然科学基金项目(81770541);国家临床重点专科建设项目(425Z8)。

摘　　要：目的观察以胸膝卧位提肛锻炼为主的综合保守治疗在直肠内脱垂导致的出口梗阻型便秘患者中的疗效。方法纳入2021年1月至2022年4月于陆军军医大学大坪医院普通外科门诊就诊的63例直肠内脱垂导致的出口梗阻型便秘患者作为研究对象,其中16例患者因为无法联系或不能坚持胸膝卧位提肛锻炼等中止研究,最终纳入47例患者进行研究。所有患者均采用以胸膝卧位提肛锻炼为主的综合保守治疗进行治疗,治疗时间为2个月。采用患者报告结局(PRO)作为疗效评价指标,PRO的主要评价指标为治疗2个月后患者自觉症状的总体改善情况,次要评价指标为治疗前、治疗2个月后患者Wexner便秘评分、排粪梗阻综合征(ODS)评分及便秘患者生活质量自评问卷(PAC-QOL)评分的变化情况。结果经过2个月的以胸膝卧位提肛锻炼为主的综合保守治疗,在完成治疗与随访的47例患者中,根据PRO结果,完全改善1例,明显改善4例,部分改善36例,没有改善6例。总计41例治疗有效,6例治疗无效,有效率为87.2%。治疗后,47例患者Wexner便秘评分的排粪频率、排粪困难程度、排粪不尽感、排粪时间维度评分及总分,ODS评分的排粪时间、每天排粪次数、排粪费力维度评分及总分,PAC-QOL各维度(身体不适,心理不适,担忧与焦虑,满意度)评分及总分均低于治疗前(均P<0.05)。结论以胸膝卧位提肛锻炼为主的综合保守治疗可以改善直肠内脱垂导致的出口梗阻型便秘患者的自觉症状,减轻便秘症状严重程度,提高生活质量。Objectives To investigate the effect of comprehensive conservative treatment primarily encompassing anal sphincter exercises at knee-chest position for treating outlet obstruction constipation due to internal rectal prolapse.Methods Sixty-three patients with outlet obstruction constipation due to internal rectal prolapse attending the Outpatient Clinic of General Surgery at the Daping Hospital—Army Medical Center,Army Medical University,between January 2021 and April 2022 were recruited.Sixteen patients dropped out due to loss of follow-up or inability to continue sphincter exercises at knee-chest position.The study finally comprised 47 patients.All patients underwent comprehensive conservative treatment for 2 months.Effectiveness was evaluated using patient-reported outcomes(PROs).The primary PRO was patient-reported overall improvement of symptoms at 2 months after treatment.Secondary PROs were the Wexner constipation scale,obstructed defecation syndrome(ODS)score,and patient assessment of constipation quality of life questionnaire(PAC-QOL)score;all these PROs were measured before treatment and at 2months after treatment to determine their changes.Results After 2 months of comprehensive conservative treatment primarily encompassing anal sphincter exercises at knee-chest position,one patient was completely improved,4 patients were markedly improved,36 patients were partially improved,and 6 patients were not improved.The treatment was effective in 41 patients and ineffective in 6,with an overall effectiveness rate of 87.2%.After treatment,the followings scores were significantly lower(P<0.05):dimension scores of bowel movements frequency,difficulty and completeness of evacuation,and time in lavatory per attempt of the Wexner constipation scale as well as the total score of the Wexner constipation scale;dimension scores of time to evacuate,daily frequency of bowel movements,difficulty to evacuate of the ODS as well as the total score of the ODS;dimension scores(physical discomfort,psychosocial discomfort,worries

关 键 词：出口梗阻型便秘 直肠内脱垂 胸膝卧位提肛锻炼 综合保守治疗 

分 类 号：R574.62[医药卫生—消化系统]