Some Questions about the Diagnosis and Treatment of Chronic NonSpecific Constipation_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

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喻德洪 , 金黑鹰

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Keywords：

便秘; 慢传输型便秘; 盒底肌功能不良

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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］。

Citation： 喻德洪,金黑鹰. Some Questions about the Diagnosis and Treatment of Chronic NonSpecific Constipation. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2003, 10(3): 207-208. doi: Copy

1.	喻德洪. 现代肛肠外科学 [M]. 北京：人民军医出版社， 1997∶472～477.
2.	Ackermann C. Constipation: medical and surgical management. In: Marti MC, Givil IC. Surgical management of anorectal and colonic diseases [M]. 2nd ed. Berlin: SpringVerlag, 1998∶331～337.
3.	Pemberton JH, Rath DM, Ilstrup DM. Evaluation and surgical treatment of severe chronic constipation [J]. Ann Surg, 1991; 124(4)∶403.
4.	Voderholzer WA, Wiebecke B, Gerum M, et al. Dysplasia of the submucous nerve plexus in slowtransit constipation of adults [J]. Eur J Gastroenterol Hepatol, 2000; 12(7)∶755.
5.	Wedel T, Roblick UJ, Ott V, et al. Oligoneuronal hypoganglionosis in patients with idiopathic slowtransit constipation [J]. Dis Colon Rectum, 2002; 45(1)∶54.
6.	ElSalhy M, Norrgard O, Spinnell S. Abnormal colonic endocrine cells in patients with chronic idiopathic slowtransit constipation [J]. Scand J Gastroenterol, 1999; 34(10)∶1007.
7.	ElSalhy M, Norrgard O. Colonic neuroendocrine peptied levels in patients with chronic idiopathic slow transit constipation [J]. Ups J Med Sci, 1998; 103(3)∶223.
8.	MitoloChieppa D, Mansi G, Rinaldi R, et al. Cholinergic stimulation and nonadrenergic, noncholinergic relaxation of human colonic circular muscle in idiopathic chronic constipation [J]. Dig Dis Sci, 1998; 43(12)∶2719.
9.	Tomita R, Fujisaki S, Ikeda T, et al. Role of nitric oxide in the colon of patients with slowtransit constipation [J]. Dis Clolon Rectum, 2002; 45(5)∶ 593.
10.	Pluta H, Bowes KL, Jewell LD. Longterm results of total abdominal colectomy for chronic idiopathic constipation [J]. Dis Colon Rectum, 1996; 39(2)∶160.
11.	Fasth S,Hedlund H, Svaninger G, et al. Functional results after subtotal colectomy and caecorectal anastomosis [J]. Acta Chir Scand, 1983; 149(6)∶623.
12.	Vasilevsky CA, Nemer FD, Balcos EG, et al. Is subtotal colectomy a viable option in the management of chronic constipation? [J]. Dis Colon Rectum, 1988; 31(9)∶679.

1. 喻德洪. 现代肛肠外科学 [M]. 北京：人民军医出版社， 1997∶472～477.
2. Ackermann C. Constipation: medical and surgical management. In: Marti MC, Givil IC. Surgical management of anorectal and colonic diseases [M]. 2nd ed. Berlin: SpringVerlag, 1998∶331～337.
3. Pemberton JH, Rath DM, Ilstrup DM. Evaluation and surgical treatment of severe chronic constipation [J]. Ann Surg, 1991; 124(4)∶403.
4. Voderholzer WA, Wiebecke B, Gerum M, et al. Dysplasia of the submucous nerve plexus in slowtransit constipation of adults [J]. Eur J Gastroenterol Hepatol, 2000; 12(7)∶755.
5. Wedel T, Roblick UJ, Ott V, et al. Oligoneuronal hypoganglionosis in patients with idiopathic slowtransit constipation [J]. Dis Colon Rectum, 2002; 45(1)∶54.
6. ElSalhy M, Norrgard O, Spinnell S. Abnormal colonic endocrine cells in patients with chronic idiopathic slowtransit constipation [J]. Scand J Gastroenterol, 1999; 34(10)∶1007.
7. ElSalhy M, Norrgard O. Colonic neuroendocrine peptied levels in patients with chronic idiopathic slow transit constipation [J]. Ups J Med Sci, 1998; 103(3)∶223.
8. MitoloChieppa D, Mansi G, Rinaldi R, et al. Cholinergic stimulation and nonadrenergic, noncholinergic relaxation of human colonic circular muscle in idiopathic chronic constipation [J]. Dig Dis Sci, 1998; 43(12)∶2719.
9. Tomita R, Fujisaki S, Ikeda T, et al. Role of nitric oxide in the colon of patients with slowtransit constipation [J]. Dis Clolon Rectum, 2002; 45(5)∶ 593.
10. Pluta H, Bowes KL, Jewell LD. Longterm results of total abdominal colectomy for chronic idiopathic constipation [J]. Dis Colon Rectum, 1996; 39(2)∶160.
11. Fasth S,Hedlund H, Svaninger G, et al. Functional results after subtotal colectomy and caecorectal anastomosis [J]. Acta Chir Scand, 1983; 149(6)∶623.
12. Vasilevsky CA, Nemer FD, Balcos EG, et al. Is subtotal colectomy a viable option in the management of chronic constipation? [J]. Dis Colon Rectum, 1988; 31(9)∶679.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Some Questions about the Diagnosis and Treatment of Chronic NonSpecific Constipation

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