Wexner S D, Cheape J D, Jorge J M, Heymen S, Jagelman D G
Department of Colorectal Surgery, Cleveland Clinic Florida, Fort Lauderdale.
Dis Colon Rectum. 1992 Feb;35(2):145-50. doi: 10.1007/BF02050669.
Eighteen patients with chronic constipation were diagnosed as having paradoxical puborectalis contraction (PPC) as the cause for their constipation. The diagnosis of PPC was made after office evaluation, colonic transit study, manometry, cinedefecography, and electromyography (EMG). These 18 patients had a mean duration of symptoms of 26.9 years; none of these patients had unassisted bowel movements. Fourteen patients had a mean of 4.6 laxative-induced bowel evacuations per week, and 11 patients had a mean of 4.4 enema-induced bowel evacuations per week. Patients underwent a mean of 8.9 one-hour EMG-based biofeedback sessions. At a mean follow-up of 9.1 (range, 0.5-12) months, these 18 patients had a mean of 7.3 unassisted bowel actions per week (P less than 0.0001). In addition, persistent laxative use was reported by only two patients, and, in both cases, this was once a week or less (P less than 0.001). Similarly, enema use was reported by only three patients, one once weekly and the other two thrice weekly (P less than 0.002). No biofeedback-related complications were identified. EMG-based biofeedback is a valuable technique associated with an 89 percent success rate in the treatment of PPC.
18例慢性便秘患者被诊断为矛盾性耻骨直肠肌收缩（PPC）是其便秘的病因。PPC的诊断是在门诊评估、结肠传输试验、测压、排粪造影和肌电图（EMG）检查后做出的。这18例患者的平均症状持续时间为26.9年；这些患者均无自主排便。14例患者每周平均有4.6次使用泻药后的排便，11例患者每周平均有4.4次灌肠后的排便。患者平均接受了8.9次基于EMG的1小时生物反馈治疗。在平均9.1（范围0.5 - 12）个月的随访中，这18例患者每周平均有7.3次自主排便（P < 0.0001）。此外，只有2例患者报告持续使用泻药，且在这两种情况下，使用频率均为每周一次或更少（P < 0.001）。同样，只有3例患者报告使用灌肠，1例每周一次，另外2例每周三次（P < 0.002）。未发现与生物反馈相关的并发症。基于EMG的生物反馈是一种有价值的技术，治疗PPC的成功率为89%。
