Objective To evaluate the safety and efficacy of procedure for prolapse and hemorrhoids （PPH） combined with Shaobei injection in treatment for obstructed defecation syndrome （ODS） caused by rectocele. Methods Seventy-two female patients with rectocele from December 2009 to January 2011 in this hospital were divided into PPH combined with Shaobei injection group （36 cases） and only PPH group （36 cases）. The Longo ODS score was performed on week one，month one，month three，and month six after operation，respectively；pain was evaluated， complications such as urine retention，postoperative bleeding，and anal function were observed；hospital stay and recovery work time were recorded in two groups. Results All patients were followed up for 6 months，there were no significant differences in complications，hospital stay，and the Longo ODS score on week one and month one after operation between two groups （P＞0.05）. But the Longo ODS score of the PPH combined with Shaobei injection group on month three and month six after operation were significantly lower than those of the only PPH group （P＜0.05）. Conclusion PPH combined with Shaobei injection has a better efficacy as compared with only PPH，and at least as safe as only PPH.
目的总结结肠冗长症合并结直肠癌的临床病理特征，并文献复习结肠冗长症与结直肠癌的关系。 方法回顾性分析兰州大学第一医院普外一科2011年1月至2012年12月期间收治的17例结肠冗长症合并结直肠癌患者的临床资料。 结果184例结直肠癌患者中合并结肠冗长症17例（9.24%），合并家族性息肉病恶变2例（1.09%），合并遗传性非息肉病性结直肠癌1例（0.54%），合并炎症性肠病1例（0.54%）。合并结肠冗长症的比例较高（P＜0.05）。其中术前经结肠气钡灌肠检查诊断为结肠冗长症5例，术中诊断为结肠冗长症12例。所有患者均行手术治疗，切除结肠13～80 cm，平均33.8 cm。术后发生肺部感染、切口液化1例，腹水1例，肠瘘1例，骶前感染1例。术后17例患者均获随访，随访时间6～12个月，中位数为10个月。随访期间，1例患者于术后1年出现卵巢转移。 结论结肠冗长症合并顽固性便秘可能是结直肠癌发病的高危因素。
Objective To explore the medium- and long-term clinical effects of procedure for prolapse and hemorrhoids (PPH) combined with Block operation for obstructed defecation syndrome (ODS). Methods Clinical data of 187 patients with ODS caused by rectocele (RE) who received PPH+Block operation or pure PPH operation in The Chaoyang City Central Hospital from Mar. 2011 to May. 2013, were collected retrospectively, in which 95 patients underwent PPH+Block operation (PPH+Block group) and 92 patients underwent PPH operation (PPH group). Compared the postoperative Longo’s score, postoperative clinical effect, operative effect, and recurrence rate between the 2 groups. Results ① The postoperative Longo’s score: the postoperative Longo’s scores of the PPH+Block group were both lower than those of the PPH group at 1- and 3-year after operation (P<0.05). ② Postoperative curative effect: the total effective rate of the PPH+Block group and the PPH group were both 100%, but the clinical effect of the the PPH+Block group was better than that of the PPH group (Z=–10.15, P<0.05). ③ Operative effect: there was no statistical significance on operative time, intraoperative blood loss, returned to normal activity time, hospital stay, and postoperative visual analogy score (VAS) between the 2 groups (P>0.05). In addition, there were no statistical significance on the incidences of urinary retention, hematochezia, exhaust anal incontinence, and anal fissure between the 2 groups (P>0.05), but the incidence of urgent or high anal straining feeling in the PPH+Block group was significantly higher than that of the PPH group (P<0.05). ④ Medium- and long-term recurrence rate: the recurrence rate of 1-year after operation was similar between these2 groups (P>0.05), but the recurrence rate of 3-year after operation in the PPH+Block group was significantly lower than that of the PPH group (P<0.05). Conclusions The medium clinical effect has no obvious difference between PPH+Block and PPH operation, but the long-term recurrence rate of the former is lower than that of the latter, and the medium- and long-term effect is stable in PPH+Block operation for ODS caused by RE.
ObjectiveTo evaluate the functional outcomes and quality of life in patients with surgery for slow transit constipation (STC).MethodsFrom March 2013 to July 2017, 29 patients undergoing total or subtotal colectomy for STC in our department were analyzed prospectively. Their preoperative and postoperative 1-year follow-up details were analyzed. Evacuation function of all patients was assessed by bowel movements, abdominal pain, bloating, straining, laxative, enema use and the Wexner constipation scales. Quality of life was evaluated by the Gastrointestinal Quality of Life Index (GIQLI) and the short-form (SF)-36 survey.ResultsA high number of patients (93.1%, 27/29) in STC stated that surgery received benefits to their health. Compared with that before operation, the number of bowel movements per week during a 1-year follow-up increased significantly (31.6±19.9 vs. 1.21±0.6, P<0.05). Significant trends toward improvement of bloating, straining, laxative and enema use were noted 1-year following surgery (P<0.05). The Wexner constipation scales scores during a 1-year follow-up decreased significantly (5.69±3.4 vs. 20.34±0.6, P<0.05). The GIQLI scores during a 1-year follow-up increased significantly (120.7±20.4 vs. 78.6±17.3, P<0.05). Moreover, results of SF-36 showed significant improvements in 7 spheres (role physical, role emotional, physical pain, vitality, mental health, social function and general health) during a 1-year follow-up compared with those before operation (P<0.05).ConclusionTotal or subtotal colectomy for STC did not only alleviate constipation symptoms dramatically, but also received significant improvements in the patients’ quality of life.
ObjectiveTo explore the clinical effect of healthy education on functional constipation caused by unhealthy lifestyle, and to analyze the disadvantages affecting the curative effect. MethodsA total of 167 cases of functional constipation from February 2009 to February 2012 were included. All of the patients were followed up for one year. We collected clinical data of curative effect and influencing factors, determined the clinical value of healthy education, and analyzed the influence of different factors on the curative effect of healthy education. ResultsThe total curative effect after one-year follow-up was 84.4%. The curative effect in elderly patients was significantly higher than that in middle-aged ones (P<0.05). The curative effect in urban patients was remarkably higher than that in rural ones (P<0.05). And the curative effect of patients with college degree wass much higher than that in patients with education background of primary school or below (P<0.05). ConclusionHealthy education has important value on releasing and eliminating functional constipation caused by unhealthy lifestyle. And it needs individual education aimed at patients with different age, education degree, and domicile.
Objective To investigate the express of ERβ protein in female slow transit constipation (STC) patients. Methods Immunohistochemistry and Western blot technique were used to detect the distribution and expression of estrogen receptor β (ERβ) protein of 20 patients with STC and 20 aged-matched controls. Results ERβ expressions were detected in mucous layer, myenteric nerve plexus and submucous nerve plexus in two groups. In comparison with the control group, the expression of ERβ protein of STC group was much lower (Plt;0.01). The expression of ERβ protein of sigmoid colon in STC group was significantly lower than that in control group (Plt;0.05). Conclusion The expression of ERβ protein decreased in myenteric and submucous nerve plexus of sigmoid colon tissues may involve in the pathogenesis of STC.
Objective To explore the effect of triple viable bifidobacterium lactobacillus tablets combined with polyethylene glycol 4000 on elderly patients with chronic constipation. Methods This pilot study was conducted at the Center of Gerontology and Geriatrics, West China Hospital. A total of 120 patients with chronic constipation, aged 60 years or older, treated between April 2015 and April 2016 were enrolled, and randomly assigned into group A (polyethylene glycol 4000) and group B (triple viable bifidobacterium lactobacillus tablets combined with polyethylene glycol 4000) with 60 patients in each. All the patients were estimated before and after the treatment with Bristol Stool Form Scale (BSFS), Patient Assessment of Constipation Symptom (PAC-SYM) and Constipation Related Disability (CRDS), and the adverse drug reactions were observed. Results In group A, before the treatment, the scores of BSFS, PAC-SYM and CRDS were 1.98±0.77, 37.87±4.12 and 31.03±3.19, respectively; while after the treatment, the scores were 3.87±0.82, 28.55±2.15 and 18.56±1.80, respectively, which were all significantly improved (P<0.05). In group B, before the treatment, the scores of BSFS, PAC-SYM and CRDS were 2.03±0.78, 36.25±4.98 and 30.28±3.56, respectively; while after the treatment, the scores were 4.80±0.75, 19.73±3.42 and 13.80±2.36, respectively, which were all significantly improved (P<0.05). The improvement of constipation in group B was significantly better than that in group A after treatment (P<0.05). There was no adverse drug reaction observed. Conclusion Triple viable bifidobacterium lactobacillus tablets combined with polyethylene glycol 4000 may be an effective therapy for elderly patients with chronic constipation.
1概述便秘是很常见的症状，在美国便秘的发生率为2%，英国为10%，日本为4%，我国天津为4.4%［1］，女性发病概率是男性的3倍。多数便秘患者可经药物治疗治愈或改善症状，少数为难治性。少数便秘患者经手术治疗效果较好。便秘不是一种病，而是多种疾病的一个症状，不同的患者有不同的含义，包括： ①大便量少、硬，排出困难； ②排便困难合并一些特殊的症候群，如长期用力排便、直肠胀感、排便不完全或依靠手法帮助排便； ③7天内排便次数少于2～3次。临床上常诊断为慢性顽固性便秘或特发性便秘，但其确切含义很难描述。“慢性”意指病史至少2年，或年幼时就发病； “特发性”说明我们对便秘的原因及流行病学了解不全面； “顽固性”意指经一般药物及非手术治疗很难奏效，常需手术治疗［2］。