论文部分内容阅读
目的:探讨特发性便秘的治疗。材料与方法:治疗特发性便秘197例,其中慢传输型便秘24例,出口梗阻型便秘173例,后者包括直肠内套叠75例,直肠粘膜脱垂57例,耻骨直肠肌痉挛25例,直肠前膨出16例。慢传输型便秘主要表现便次少,排便间隔时间3~10d不等,少数有腹胀。直肠内套叠及直肠粘膜脱垂主要表现排便困难、排便不全、肛部坠胀、肛部阻塞、肛部疼痛、用手指插入肛门协助排便等症状。结肠传输试验:24例慢传输型便秘患者表现结肠传输障碍,标志物全部排出时间5~11d,平均7.4d。直肠内套叠及直肠粘膜脱垂患者中有25例排出时间延长至3~6d。排粪造影:直肠粘膜脱垂以前壁粘膜脱垂为主。直肠内套叠全层肠壁呈漏斗状套人,鞘部呈杯口状,伴肛直角变钝32例,会阴下降>3cm 23例。耻骨直肠肌痉挛表现耻骨直肠肌压痕加深。直肠前膨出显示直肠明显突向阴道。盆腔造影:45例行盆腔造影,34例显示直肠子宫/膀胱陷凹明显加深。24例慢传输型便秘20例行结肠次全切除术,4例行左半结肠切除术。采用硬化剂注射治疗直肠粘膜脱垂54例、直肠内套叠23例。直肠粘膜缝缩术治疗直肠粘膜脱垂3例。改良式Orr’s直肠悬吊治疗直肠内套叠52例,其中31例加乙状结肠切除术,5例因伴结肠排泄时间延迟而加行结肠次全切除术,32例女患者加行子宫悬吊。16例直肠前
Objective: To investigate the treatment of idiopathic constipation. MATERIALS AND METHODS: A total of 197 cases of idiopathic constipation were treated, including 24 cases of slow transit constipation and 173 cases of outlet obstruction constipation. The latter included 75 cases of intussusception, 57 cases of rectal mucosal prolapse and 25 cases of puborectalis muscle spasm. , Rectal prolapse in 16 cases. Slow transit constipation less than the main performance, defecation interval of 3 ~ 10d range, a few bloating. Rectal intussusception and rectal mucosal prolapse mainly manifested defecation difficulties, defecation, anal bulge, anal blockage, anal pain, anal intercourse with the help of defecation and other symptoms. Colon transport test: 24 cases of slow transit constipation showed colonic transit disorder, all markers of the discharge time 5 ~ 11d, an average of 7.4d. Rectal intussusception and rectal mucosal prolapse in patients with 25 cases of discharge time extended to 3 ~ 6d. Defecography: Rectal mucosal prolapse of the former mainly mucosal prolapse. Rectal intussusception full-thickness intestinal wall was funnel-like sets of people, the sheath was cup-shaped, with anus right angle blunt 32 cases, decreased perineal> 3cm 23 cases. Puborectalis muscle spasm manifestations of puborectalis muscle indentation deepen. Rectal prolapse showed obvious rectum to the vagina. Pelvic radiography: Pelvic imaging was performed in 45 cases, and 34 cases showed significantly deeper rectal uterus / bladder pits. 24 cases of slow transit constipation 20 cases of subtotal colon resection, 4 cases of left half of the colon resection. 54 cases of rectal mucosal prolapse were treated with sclerotherapy and 23 cases of intussusception. Rectal mucosal suture in the treatment of rectal mucosal prolapse in 3 cases. Modified Orr’s rectal suspension in the treatment of rectal intussusception in 52 cases, of which 31 cases of sigmoid resection, 5 cases of colonic excretion due to time delay plus subtotal colon resection, 32 cases of female patients with uterine suspension. 16 cases of rectum