摘要
目的 探讨针对便失禁病因的生物反馈训练方法 ,并对近期和远期疗效进行随访观察。方法 利用多种先进的客观检测手段通过不同侧面对 31例无肛患儿肛门直肠功能进行综合评定 ,根据患儿不同的控制机制异常进行加强肛周肌肉力量、改善直肠感觉阈值、缩短括约肌反应时间、建立肛门括约肌收缩反射和改善排便动力的生物反馈训练 ,并对疗效进行 5～ 7年的长期随访。结果接受生物反馈训练患儿的临床评分与生活质量评分在训练前、训练后、近期随访和远期随访分别是3.2± 1.1与 8.7± 1.1、5 .2± 0 .6与 11.0± 0 .8、5 .0± 0 .6与 10 .8± 0 .9和 4 .6± 0 .7与 10 .0± 0 .7。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明显改善 ,并出现统计学差异。结论 针对性的生物反馈训练方法对于治疗无肛术后便失禁效果非常明显 ,并且疗效能够长期保持 ,对提高患儿生活质量具有重要意义。
Objective Although better anorectal function was achieved due to the advanced operation procedures, the fecal incontinence and constipation still remain as major postoperative complications. The aim of this study was to design a individualized biofeedback program based on the underlying dysfunctions and to assess the short-term and long-term clinical and quality of life outcomes for patients with imperforate anus. Methods Thirty-one patients were treated using individualized biofeedback program according to their different dysfunctions after completed assessment of anorectal function. The many of special biofeedback training methods that consisted of the strengthening perianal muscles biofeedback, sensory discrimination biofeedback, synchronizing external sphincter contraction biofeedback and improving defecation dynamic biofeedback were selected to make up the individualized biofeedback training program. The clinical scores and quality of life scores were assessed at short-term and long-term follow-up. Results(The clinical scores) and quality of life scores in patients at before training group, after biofeedback training group, short-term follow-up group and long-term follow-up group were 3.2±1.1 and 8.7±1.1, 5.2±0.6 and11.0±0.8, 5.0±0.6 and 10.8±0.9, and 4.6±0.7 and 10.0±0.7respectively. After biofeedback training, the first leak volume and all parameters that evaluated the function of the perianal muscles were increased significantly, the abnormal rectal threshold sensations and defecation dynamics were reverted to normal, and 82% patients who have not external anal sphincter reflex acquired the new reflex. The latencies of pudendo-anal reflex have significant difference in patients with poor response compared with those patients with good response before and after the biofeedback training. At short-term follow-up 12 patients (57%) maintained the clinical outcome and only 9 patients (43%) have regressions slightly. At long-term follow-up 7 patients (33%) maintained the clinical outcome very well and 14 patients (67%) have regressions. Although the clinical and quality of life scores have decreased slightly at follow-up, they were still increased significantly compared with before biofeedback training group. Conclusion The causes of postoperative fecal dysfunction in patients with imperforate anus are multifactorial, and the individualized biofeedback is more suitable for improvement of the clinical outcome and the quality of life, and it maintain good clinical outcome and quality of life at short-term and long-term follow-up.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2004年第6期478-481,共4页
National Medical Journal of China
基金
卫生部科研基金资助项目 (98 1 191)
