Ziya Balta A, Demirbas S, Ozturk R, Yucel E, Tahir Ozer M, Ersoz N
GATA General Surgical Clinic, Division of Gastrointestinal Surgery, Ankara, Turkey.
Bratisl Lek Listy. 2011;112(1):34-40.
Constipation is often associated with some clinical signs as hard stool, incomplete defecation, chronic straining, and abdominal pain and long stays in bathroom. Some diagnostic uncertainties came from functional and structural variations of the anorectum and the assessment from few imaging procedures, which were thought as the best but could not always give the expected result. Then physiologic tests were required to be used. The aim was to study which physiologic test correlated to the clinical symptoms, was valuable and have to be performed in the patients with chronic constipation in this series.
One hundred twenty-seven patients (56.3 % females; mean age, 56.7) with chronic constipation according to the Rome II criteria were initially treated by dietary change and increased physical activation. The unresponsive (80) patients were instructed to be evaluated by the physiologic tests (anal manometry, defecography, colonic transit time-CTT) and clinical symptoms. The assessments from physiologic tests, which were originated from 4 distinctive categories, were investigated by factor analysis. ROC curve analysis was used to take involved assessments, which had a big impact on the constipation status.
80 patients, mostly female (89 %), had experienced several symptoms in 11.9 years. The CCT, scoring system, evacuation problem, hard stool, habitual laxative use and digital assist for defecation were significantly different in 17 factors originated from different categories. We analyzed the extracted factor, which had an important effect on the constipation and consequently considered the necessary physiologic test and other related symptoms.
Scoring system, CTT, anal manometry and other physiologic tests are important to establish a true diagnosis of the etiology of the constipation. However, defecography and clinical symptoms are the factors, which has a great impact on the diagnosis of constipation (Tab. 7, Ref. 25).
便秘常伴有一些临床症状，如大便干结、排便不尽、长期用力排便、腹痛以及在卫生间停留时间过长。一些诊断上的不确定性源于肛门直肠的功能和结构变化，以及少数影像学检查的评估结果，这些检查虽被认为是最佳方法，但并非总能给出预期结果。因此需要采用生理测试。本研究旨在探讨在本系列慢性便秘患者中，哪种生理测试与临床症状相关、有价值且必须进行。
127例符合罗马II标准的慢性便秘患者（女性占56.3%；平均年龄56.7岁）最初接受饮食调整和增加体力活动治疗。对无反应的80例患者进行生理测试（肛门测压、排粪造影、结肠传输时间-CTT）和临床症状评估。通过因子分析研究来自4个不同类别的生理测试评估结果。采用ROC曲线分析来确定对便秘状态有重大影响的相关评估。
80例患者中大多数为女性（89%），病程11.9年，出现多种症状。来自不同类别的17个因素中，结肠传输时间、评分系统、排便问题、大便干结、习惯性使用泻药和排便时需手法辅助等方面存在显著差异。我们分析了对便秘有重要影响的提取因子，从而确定了必要的生理测试及其他相关症状。
评分系统、结肠传输时间、肛门测压及其他生理测试对于明确便秘病因的准确诊断很重要。然而，排粪造影和临床症状是对便秘诊断有重大影响的因素（表7，参考文献25）。
