慢性便秘的动力障碍分型及其对治疗的指导意义.pdfVIP

Chin J Gastroenterol，2003，Vol 8，No．4 慢性便秘的动力障碍分型及其对治疗的指导意义 郭晓峰 柯美云 王智凤 方秀才 吴 冰 涂银萍 中国医学科学院 中国协和医科大学 北京协和医院消化内科(100730) 背景：慢性便秘是一种常见的消化道症状，且存在不同的动力障碍类型，目前尚缺乏简便、有效的分型诊断方 法。目的：探讨慢性便秘动力障碍的分型诊断方法及其对治疗的指导意义。方法：对连续入选的210例慢性便秘患者 通过病史采集、肛门直肠指检、胃肠传输试验(GITT)和肛门直肠测压(ARM)判断其动力障碍类型。综合症状和各 项检查结果制定出分型诊断方法，再进一步评估各项检查的作用。结果：210例慢性便秘患者中，出口梗阻型便秘 (OOC)、慢传输型便秘(STC)和混合型便秘(MC)分别占50．8％、10．2％和39．0％。STC或伴有慢传输的MC患者粪 便常较坚硬(P=0．036)；肛门直肠指检力排时肛门括约肌反向性收缩和ARM力排时肛门括约肌压力反相性升高对 判断有无出口梗阻很有意义(P0．001)；GITT中不透X线标志物48 h时在腹部的分布对判断有无慢传输很有意义 (P0．001 o肛门直肠指检、GITT和ARM的敏感性分别为82．5％、89．1％和94．4％；特异性分别为85．2％、87．9％和 92．6％。经分型后，有69．5％的患者改进了治疗方案。结论：慢性便秘的症状、肛门直肠指检、GITT和ARM是判断其 动力障碍类型的有效方法，肛门直肠指检和ARM可提高OOC的诊断正确率，GITT有助于诊断STC。正确的分型对 临床治疗有重要指导意义。 关键词 便秘； 动力障碍； 胃肠通过试验； 肛门直肠测压 The Patterns of Motor Dysfunction in Patients with Chronic C0nstipati0n and the Guiding Roles in its Management GUo Xiaofeng，KE Meiyan．WANG zhtfeng，FANG Xiucai．WU Bing,TU Yinping．Department of Gastroenterology，Peking Union Medical College Hospital，Peking Union Medical College．Chinese Academy of Medical Sciences．Beijing(100730) Backgr0und：Chronic constipation is a common ga8tr0inte8tinal symptom with different patterns of motor dysfunction，which lacks of simple and effective diagnostic methods for categ0rizati0n．Aims： To appraise the diagnostic methods of motor dysfunctional patterns in patients with chronic constipa- tion and the guiding roles in its management．Methods：Two hundred and ten consecutive patients with chronic constipation were investigated by history，digital rectal examination，ga8tr0inte8tinal transit test(GITT)and anorectal manometry(ARM)to determine the patterns of motor dysfunction．The syrup- toms and results of the examinations mentioned above were summarized for establishing the dia