中华消化外科杂志
中華消化外科雜誌
중화소화외과잡지
CHINESE JOURNAL OF DIGESTIVE SURGERY
2015年
6期
488-491
,共4页
慢性便秘%多学科团队%临床评估
慢性便祕%多學科糰隊%臨床評估
만성편비%다학과단대%림상평고
Chronic constipation%Multidisciplinary team%Clinical assessment
目的 探讨对慢性便秘患者进行多学科团队(MDT)评估的临床意义.方法 选取2010年1月至2013年12月杭州市第三人民医院收治的346例慢性便秘患者进行前瞻性研究,采用临床调查研究法对入组患者进行肛肠外科、泌尿外科、妇科、精神心理科的多学科临床特征评估,包括问卷调查、排粪造影、肛门测压、结肠运输功能试验、尿流动力学、妇科等检查.正态分布的计量资料采用(x)±s表示,组间的比较采用方差分析,计数资料比较采用x2检验.结果 筛选出符合本研究条件的患者346例,男86例,女260例,男女比例为1:3;年龄为(55±11)岁.346例患者中慢传输型便秘占7.52％(26/346)、排便障碍型便秘占60.98％(211/346)、混合型便秘占31.50％ (109/346).93.85％ (244/260)的女性患者存在直肠前突,75.43％(261/346)的患者存在直肠黏膜内脱垂,66.76％ (231/346)的患者存在会阴下降,23.99％(83/346)的患者存在内括约肌失迟缓或排便时反常收缩,18.79％(65/346)的患者存在耻骨直肠肌肥厚,5.49％(19/346)的患者存在直肠外脱垂.82.37％(285/346)的患者存在肛肠外科之外的疾病.28.61％(99/346)的患者伴有泌尿系统症状,其中压力性尿失禁65例、不稳定性膀胱23例、膀胱出口梗阻19例(部分患者合并多项泌尿系统症状).女性患者中生殖器官脱垂发生率为31.92％(83/260),其中子宫脱垂发生率为26.15％ (68/260),阴道前壁膨出发生率为29.23％(76/260).心理评估后发现焦虑和(或)抑郁患者占36.13％(125/346).慢传输型便秘、排便障碍型便秘、混合型便秘患者男女各10例和16例、30例和79例、46例和165例,3种类型便秘患者年龄分别为(60±12)岁、(56±11)岁、(52±10)岁,3者男女性别比例、年龄比较,差异无统计学意义(x2=4.046,F=2.877,P＞0.05).3种类型便秘患者中,合并泌尿外科疾病患者比例分别为26.92％(7/26)、26.61％(29/109)和29.86％(63/211),合并妇科疾病患者比例分别为11.54％(3/26)、20.18％(22/109)、27.49％(58/211),合并心理疾病患者比例为38.46％ (10/26)、39.45％(43/109)、34.12％(72/211),3类患者在合并泌尿外科、妇科、心理疾病3方面比较,差异无统计学意义(x2=4.090,P＞0.05).结论 对慢性便秘患者的MDT评估能够较全面地反映慢性便秘的临床特点;该病临床诊断应该注重MDT的合作.
目的 探討對慢性便祕患者進行多學科糰隊(MDT)評估的臨床意義.方法 選取2010年1月至2013年12月杭州市第三人民醫院收治的346例慢性便祕患者進行前瞻性研究,採用臨床調查研究法對入組患者進行肛腸外科、泌尿外科、婦科、精神心理科的多學科臨床特徵評估,包括問捲調查、排糞造影、肛門測壓、結腸運輸功能試驗、尿流動力學、婦科等檢查.正態分佈的計量資料採用(x)±s錶示,組間的比較採用方差分析,計數資料比較採用x2檢驗.結果 篩選齣符閤本研究條件的患者346例,男86例,女260例,男女比例為1:3;年齡為(55±11)歲.346例患者中慢傳輸型便祕佔7.52％(26/346)、排便障礙型便祕佔60.98％(211/346)、混閤型便祕佔31.50％ (109/346).93.85％ (244/260)的女性患者存在直腸前突,75.43％(261/346)的患者存在直腸黏膜內脫垂,66.76％ (231/346)的患者存在會陰下降,23.99％(83/346)的患者存在內括約肌失遲緩或排便時反常收縮,18.79％(65/346)的患者存在恥骨直腸肌肥厚,5.49％(19/346)的患者存在直腸外脫垂.82.37％(285/346)的患者存在肛腸外科之外的疾病.28.61％(99/346)的患者伴有泌尿繫統癥狀,其中壓力性尿失禁65例、不穩定性膀胱23例、膀胱齣口梗阻19例(部分患者閤併多項泌尿繫統癥狀).女性患者中生殖器官脫垂髮生率為31.92％(83/260),其中子宮脫垂髮生率為26.15％ (68/260),陰道前壁膨齣髮生率為29.23％(76/260).心理評估後髮現焦慮和(或)抑鬱患者佔36.13％(125/346).慢傳輸型便祕、排便障礙型便祕、混閤型便祕患者男女各10例和16例、30例和79例、46例和165例,3種類型便祕患者年齡分彆為(60±12)歲、(56±11)歲、(52±10)歲,3者男女性彆比例、年齡比較,差異無統計學意義(x2=4.046,F=2.877,P＞0.05).3種類型便祕患者中,閤併泌尿外科疾病患者比例分彆為26.92％(7/26)、26.61％(29/109)和29.86％(63/211),閤併婦科疾病患者比例分彆為11.54％(3/26)、20.18％(22/109)、27.49％(58/211),閤併心理疾病患者比例為38.46％ (10/26)、39.45％(43/109)、34.12％(72/211),3類患者在閤併泌尿外科、婦科、心理疾病3方麵比較,差異無統計學意義(x2=4.090,P＞0.05).結論 對慢性便祕患者的MDT評估能夠較全麵地反映慢性便祕的臨床特點;該病臨床診斷應該註重MDT的閤作.
목적 탐토대만성편비환자진행다학과단대(MDT)평고적림상의의.방법 선취2010년1월지2013년12월항주시제삼인민의원수치적346례만성편비환자진행전첨성연구,채용림상조사연구법대입조환자진행항장외과、비뇨외과、부과、정신심이과적다학과림상특정평고,포괄문권조사、배분조영、항문측압、결장운수공능시험、뇨류동역학、부과등검사.정태분포적계량자료채용(x)±s표시,조간적비교채용방차분석,계수자료비교채용x2검험.결과 사선출부합본연구조건적환자346례,남86례,녀260례,남녀비례위1:3;년령위(55±11)세.346례환자중만전수형편비점7.52％(26/346)、배편장애형편비점60.98％(211/346)、혼합형편비점31.50％ (109/346).93.85％ (244/260)적녀성환자존재직장전돌,75.43％(261/346)적환자존재직장점막내탈수,66.76％ (231/346)적환자존재회음하강,23.99％(83/346)적환자존재내괄약기실지완혹배편시반상수축,18.79％(65/346)적환자존재치골직장기비후,5.49％(19/346)적환자존재직장외탈수.82.37％(285/346)적환자존재항장외과지외적질병.28.61％(99/346)적환자반유비뇨계통증상,기중압력성뇨실금65례、불은정성방광23례、방광출구경조19례(부분환자합병다항비뇨계통증상).녀성환자중생식기관탈수발생솔위31.92％(83/260),기중자궁탈수발생솔위26.15％ (68/260),음도전벽팽출발생솔위29.23％(76/260).심리평고후발현초필화(혹)억욱환자점36.13％(125/346).만전수형편비、배편장애형편비、혼합형편비환자남녀각10례화16례、30례화79례、46례화165례,3충류형편비환자년령분별위(60±12)세、(56±11)세、(52±10)세,3자남녀성별비례、년령비교,차이무통계학의의(x2=4.046,F=2.877,P＞0.05).3충류형편비환자중,합병비뇨외과질병환자비례분별위26.92％(7/26)、26.61％(29/109)화29.86％(63/211),합병부과질병환자비례분별위11.54％(3/26)、20.18％(22/109)、27.49％(58/211),합병심리질병환자비례위38.46％ (10/26)、39.45％(43/109)、34.12％(72/211),3류환자재합병비뇨외과、부과、심리질병3방면비교,차이무통계학의의(x2=4.090,P＞0.05).결론 대만성편비환자적MDT평고능구교전면지반영만성편비적림상특점;해병림상진단응해주중MDT적합작.
Objective To investigate the clinical value of multidisciplinary team (MDT) assessment for chronic constipation.Methods The clinical characteristics of 346 patients with chronic constipation who were admitted to the Third Peolep's Hospital of Hangzhou from January 2010 to December 2013 were multidisciplinarily assessed.The muhidisciplinary team was involved surgeons from the department of colorectal surgery,urology,gynecology,psychiatry and psychology,and tools including questionnaires,defecography,anorectal manometry,colon transit study,urodynamic tests,gynecological examination were applied in the study.The measurement data with normal distribution were presented as (x) ± s,the comparison between groups was analyzed using the ANOVA,and the count data were analyzed using the chi-square test.Results Three hundred and forty-six patients who met criteria of this research were selected,including 86 males and 260 females with the ratio of 1 ∶ 3;the mean age was (55 ± 11)years.Of the 346 patients,slow transit constipation accounted for 7.52％ (26/346),defecatory disorder for 60.98％ (211/346),and mixed constipation for 31.50％ (109/346).A total of 93.85％ female patients (244/260) had anterior rectocele,75.43％ (261/346) patients had internal rectal mucosal prolapse,66.76％ (231/346) patients had perineum descending,23.99％ (83/346) had achalasia or inappropriate contraction of internal anal sphincter,18.79％ (65/346) had puborectalis rectocele muscle thickening,5.49％ (19/346) had rectal prolapse.A total of 82.37％ (285/346) patients were involved in other subjects than colorectal surgery.A total of 28.61％ (99/346) patients presented with urinary symptoms,including 65 cases with stress urinary incontinence,23 cases with unstable bladder and 19 cases with bladder neck obstruction (some patients had multiple urological systoms).The incidence of reproductive organ prolapse in female patients was 31.92％ (83/260),the incidence of uterine prolapse and anterior vaginal prolapse were 26.15％ (68/260) and 29.23％ (76/260),respectively.Patients with anxiety and/or depression accounted for 36.13％ (125/346).The male and female patients of slow transit constipation,defecatory constipation and mixed constipation were 10 vs 16,30 vs 79,46 vs 165,respectively,the age was 60 ± 12,56 ± 11,52 ± 10,showing no significant differences (x2=4.046,F =2.877,P ＞ 0.05).In the three kinds of constipation,patients with urinary diseases accounted for 26.92％ (7/26),26.61％ (29/109) and 29.86％ (63/211),patients with gynecological diseases accounted for 11.54％ (3/26),20.18％ (22/109),27.49％ (58/211),patients with psychological diseases accounted for 38.46％ (10/26),39.45％ (43/109),34.12％ (72/211),respectively,showing no significant difference (x2=4.090,P ＞ 0.05).Conclusion MDT assessment for patients with chronic constipation can reflect comprehensively clinical characteristics of chronic constipation,therefore multidisciplinary team should be emphasized in clinical diagnosis and treatment of chronic constipation.
