直肠癌保肛手术后肛门功能障碍的生物反馈治疗
苏琪,吴硕东, 袁正伟, 王伟, 殷红专, 韩霞, 刘恩卿,中国医科大学附属盛京医院普通外科 辽宁省沈阳市 110004.
辽宁省自然科学基金资助项目,No. 972255
辽宁省教育厅资助项目,No. 202010792
项目负责人:苏琪, 110004, 辽宁省沈阳市和平区三好街36号, 中国医科大学附属盛京医院普通外科. suqi100@hotmail.com
电话:024-83955072
收稿日期:2004-12-10 接受日期:2004-12-21
摘要
目的: 探讨直肠癌保肛手术后肛门功能障碍的治疗方法.
方法: 利用多种先进的客观检测手段，通过不同侧面对31例直肠癌保肛手术后肛门功能进行综合评定，并根据患者不同的排便功能障碍机制，选择性进行加强肛周肌肉力量、改善直肠感觉阈值等5种方法的生物反馈训练.
结果: 接受生物反馈训练的中低位直肠癌患者临床评分由2.3±1.0提高至4.6±0.5，而高位直肠癌由3.7±1.0提高至5.7±0.5.经过训练之后，代表肛周肌肉力量、直肠功能和直肠肛管综合控制能力的指标均有非常明显的改善，统计学处理差异有显著性意义.
结论: 针对性的生物反馈训练方法对于治疗直肠癌保肛手术后肛门功能障碍具有的非常显著效果，对提高患者生活质量具有重要意义.
苏琪,吴硕东, 袁正伟,王伟,殷红专, 韩霞,刘恩卿.直肠癌保肛手术后肛门功能障碍的生物反馈治疗.世界华人消化杂志 2005;13(3):419-423
Park UC, Choi SK, Piccirillo MF, Verzaro R, Wexner SD. Patterns ofanismus and the relation to biofeedback therapy.
Dis Colon Rectum 1996;39:768-773
2 Ho YH, ChiangJM, Tan M, Low JY. Biofeedback therapy for excessive stool frequency andincontinence
followinganterior resection or totalcolectomy. Dis Colon Rectum 1996;39:1289-1292
3 Gilliland R,Heymen S, Altomare DF, Park UC, Vickers D, Wexner SD. Outcome andpredictors of success of biofeedback
for constipation. Br J Surg 1997;84:1123-1126
4 Patankar SK,Ferrara A, Levy JR, Larach SW, Williamson PR, Perozo SE. Biofeedback incolorectal practice:a
multicenter, statewide, three-yearexperience. Dis Colon Rectum 1997;40:827-831
5 Ho YH, Tan M.Biofeedback therapy for bowel dysfunction following low anteriorresection. Ann Acad Med
Singapore 1997;26:299-302
6 Gilliland R,Heymen JS, Altomare DF, Vickers D, Wexner SD. Biofeedback for intractablerectal pain:outcome and
predictors of success. Dis ColonRectum 1997;40:190-196
7 Heah SM, Ho YH,Tan M, Leong AF. Biofeedback is effective treatment for levator anisyndrome.
Dis Colon Rectum 1997;40:187-189
8 Ho YH, Tan M,Goh HS. Clinical and physiologic effects of biofeedback in outletobstruction constipation.
Dis Colon Rectum 1996;39:520-524
9 Solomon MJ, RexJ, Eyers AA, Stewart P, Roberts R. Biofeedback for fecal incontinenceusing
transanal ultrasonography:novel approach. Dis Colon Rectum 2000;43:788-792
10 Lau CW, HeymenS, Alabaz O, Iroatulam AJ, Wexner SD. Prognostic significance of rectocele,intussusception,and abnormal perineal descent in biofeedback treatment for constipated patients withparadoxical
puborectalis contraction. DisColon Rectum 2000;43:478-482
11 Heymen S,Wexner SD, Vickers D, Nogueras JJ, Weiss EG, Pikarsky AJ. Prospective,randomized trial comparing
four biofeedback techniquesfor patients with constipation. Dis Colon Rectum 1999;42:1388-1393
12 Mollen RM,Salvioli B, Camilleri M, Burton D, Kost LJ, Phillips SF, Pemberton JH. Theeffects of biofeedback on
rectal sensation and distalcolonic motility in patients with disorders of rectal evacuation:evidenceof an
inhibitory rectocolonic reflexin humans? Am J Gastroenterol 1999;94:751-756
13 Mavrantonis C,Wexner SD. A clinical approach to fecal incontinence. J ClinGastroenterol 1998;27:108-121
14 苏琪,吴硕东. 直肠癌术后肛门外括约肌的电生理研究. 中国临床康复 2004;8:3308-3309
15 王军,齐清会, 董作亮. 生物反馈治疗慢性顽固性特发性便秘的临床研究.基础医学与临床 2001;21:91
16 Palsson OS, Heymen S, Whitehead WE. Biofeedback treatment for functional anorectal disorders:a
comprehensive efficacy review. Appl Psychophysiol Biofeedback 2004;29:153-174
17 Bharucha AE. Treatment of severe and intractable constipation. Curr Treat Options Gastroenterol 2004;7:291-298
18 Beddy P, Neary P, Eguare EI, McCollum R, Crosbie J, Conlon KC, Keane FB. Electromyographic biofeedback can
improve subjective and objective measures of fecal incontinence in the short term. J Gastrointest Surg 2004;8:64-72
19 Battaglia E, Serra AM, Buonafede G, Dughera L, Chistolini F, Morelli A, Emanuelli G, Bassotti G. Long-term study on
the effects of visual biofeedback and muscle training as a therapeutic modality in pelvic floor dyssynergia and
slow-transit constipation. Dis Colon Rectum 2004;47:90-95
20 Martinez-Puente Mdel C, Pascual-Montero JA, Garcia-Olmo D. Customized biofeedback therapy improves results in
fecal incontinence. Int J Colorectal Dis 2004;19:210-214
21 Fernandez-Fraga X, Azpiroz F, Aparici A, Casaus M, Malagelada JR. Predictors of response to biofeedback treatment
in anal incontinence. Dis Colon Rectum 2003;46:1218-1225
22 Wang J, Luo MH, Qi QH, Dong ZL. Prospective study of biofeedback retraining in patients with chronic idiopathic
functional constipation. World J Gastroenterol 2003;9:2109-2113
23 Tariq SH, Morley JE, Prather CM. Fecal incontinence in the elderly patient. Am J Med 2003;115:217-227
编辑 张海宁( 苏 琪, 吴硕东, 袁正伟, 王 伟, 殷红专, 韩 霞, 刘恩卿)
辽宁省自然科学基金资助项目,No. 972255
辽宁省教育厅资助项目,No. 202010792
项目负责人:苏琪, 110004, 辽宁省沈阳市和平区三好街36号, 中国医科大学附属盛京医院普通外科. suqi100@hotmail.com
电话:024-83955072
收稿日期:2004-12-10 接受日期:2004-12-21
摘要
目的: 探讨直肠癌保肛手术后肛门功能障碍的治疗方法.
方法: 利用多种先进的客观检测手段，通过不同侧面对31例直肠癌保肛手术后肛门功能进行综合评定，并根据患者不同的排便功能障碍机制，选择性进行加强肛周肌肉力量、改善直肠感觉阈值等5种方法的生物反馈训练.
结果: 接受生物反馈训练的中低位直肠癌患者临床评分由2.3±1.0提高至4.6±0.5，而高位直肠癌由3.7±1.0提高至5.7±0.5.经过训练之后，代表肛周肌肉力量、直肠功能和直肠肛管综合控制能力的指标均有非常明显的改善，统计学处理差异有显著性意义.
结论: 针对性的生物反馈训练方法对于治疗直肠癌保肛手术后肛门功能障碍具有的非常显著效果，对提高患者生活质量具有重要意义.
苏琪,吴硕东, 袁正伟,王伟,殷红专, 韩霞,刘恩卿.直肠癌保肛手术后肛门功能障碍的生物反馈治疗.世界华人消化杂志 2005;13(3):419-423
Park UC, Choi SK, Piccirillo MF, Verzaro R, Wexner SD. Patterns ofanismus and the relation to biofeedback therapy.
Dis Colon Rectum 1996;39:768-773
2 Ho YH, ChiangJM, Tan M, Low JY. Biofeedback therapy for excessive stool frequency andincontinence
followinganterior resection or totalcolectomy. Dis Colon Rectum 1996;39:1289-1292
3 Gilliland R,Heymen S, Altomare DF, Park UC, Vickers D, Wexner SD. Outcome andpredictors of success of biofeedback
for constipation. Br J Surg 1997;84:1123-1126
4 Patankar SK,Ferrara A, Levy JR, Larach SW, Williamson PR, Perozo SE. Biofeedback incolorectal practice:a
multicenter, statewide, three-yearexperience. Dis Colon Rectum 1997;40:827-831
5 Ho YH, Tan M.Biofeedback therapy for bowel dysfunction following low anteriorresection. Ann Acad Med
Singapore 1997;26:299-302
6 Gilliland R,Heymen JS, Altomare DF, Vickers D, Wexner SD. Biofeedback for intractablerectal pain:outcome and
predictors of success. Dis ColonRectum 1997;40:190-196
7 Heah SM, Ho YH,Tan M, Leong AF. Biofeedback is effective treatment for levator anisyndrome.
Dis Colon Rectum 1997;40:187-189
8 Ho YH, Tan M,Goh HS. Clinical and physiologic effects of biofeedback in outletobstruction constipation.
Dis Colon Rectum 1996;39:520-524
9 Solomon MJ, RexJ, Eyers AA, Stewart P, Roberts R. Biofeedback for fecal incontinenceusing
transanal ultrasonography:novel approach. Dis Colon Rectum 2000;43:788-792
10 Lau CW, HeymenS, Alabaz O, Iroatulam AJ, Wexner SD. Prognostic significance of rectocele,intussusception,and abnormal perineal descent in biofeedback treatment for constipated patients withparadoxical
puborectalis contraction. DisColon Rectum 2000;43:478-482
11 Heymen S,Wexner SD, Vickers D, Nogueras JJ, Weiss EG, Pikarsky AJ. Prospective,randomized trial comparing
four biofeedback techniquesfor patients with constipation. Dis Colon Rectum 1999;42:1388-1393
12 Mollen RM,Salvioli B, Camilleri M, Burton D, Kost LJ, Phillips SF, Pemberton JH. Theeffects of biofeedback on
rectal sensation and distalcolonic motility in patients with disorders of rectal evacuation:evidenceof an
inhibitory rectocolonic reflexin humans? Am J Gastroenterol 1999;94:751-756
13 Mavrantonis C,Wexner SD. A clinical approach to fecal incontinence. J ClinGastroenterol 1998;27:108-121
14 苏琪,吴硕东. 直肠癌术后肛门外括约肌的电生理研究. 中国临床康复 2004;8:3308-3309
15 王军,齐清会, 董作亮. 生物反馈治疗慢性顽固性特发性便秘的临床研究.基础医学与临床 2001;21:91
16 Palsson OS, Heymen S, Whitehead WE. Biofeedback treatment for functional anorectal disorders:a
comprehensive efficacy review. Appl Psychophysiol Biofeedback 2004;29:153-174
17 Bharucha AE. Treatment of severe and intractable constipation. Curr Treat Options Gastroenterol 2004;7:291-298
18 Beddy P, Neary P, Eguare EI, McCollum R, Crosbie J, Conlon KC, Keane FB. Electromyographic biofeedback can
improve subjective and objective measures of fecal incontinence in the short term. J Gastrointest Surg 2004;8:64-72
19 Battaglia E, Serra AM, Buonafede G, Dughera L, Chistolini F, Morelli A, Emanuelli G, Bassotti G. Long-term study on
the effects of visual biofeedback and muscle training as a therapeutic modality in pelvic floor dyssynergia and
slow-transit constipation. Dis Colon Rectum 2004;47:90-95
20 Martinez-Puente Mdel C, Pascual-Montero JA, Garcia-Olmo D. Customized biofeedback therapy improves results in
fecal incontinence. Int J Colorectal Dis 2004;19:210-214
21 Fernandez-Fraga X, Azpiroz F, Aparici A, Casaus M, Malagelada JR. Predictors of response to biofeedback treatment
in anal incontinence. Dis Colon Rectum 2003;46:1218-1225
22 Wang J, Luo MH, Qi QH, Dong ZL. Prospective study of biofeedback retraining in patients with chronic idiopathic
functional constipation. World J Gastroenterol 2003;9:2109-2113
23 Tariq SH, Morley JE, Prather CM. Fecal incontinence in the elderly patient. Am J Med 2003;115:217-227
编辑 张海宁( 苏 琪, 吴硕东, 袁正伟, 王 伟, 殷红专, 韩 霞, 刘恩卿)