Colorectal Surgery Center, Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, Boston, Massachusetts.
Digestive Healthcare Center, Department of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts.
Dis Colon Rectum. 2019 Jan;62(1):56-62. doi: 10.1097/DCR.0000000000001250.
Recently, there has been a trend toward surgical management of internal intussusception despite an unclear correlation with constipation symptoms.
This study characterizes constipation in patients with obstructed defecation syndrome and identifies whether internal intussusception or other diagnoses such as irritable bowel syndrome may be contributing to symptoms.
Patients evaluated for obstructed defecation at a pelvic floor disorder center were studied from a prospectively maintained database. With the use of defecography, patients were classified by Oxford Rectal Prolapse Grade. Coexisting disorders such as enterocele, rectocele, and dyssynergia were also identified. The presence of irritable bowel syndrome was defined using Rome IV criteria, and constipation severity was quantified with the Varma constipation severity instrument.
This study was conducted at a tertiary care university medical center (Massachusetts General Hospital).
The study included 317 consecutive patients with defecography imaging and a completed constipation severity instrument survey from May 2007 to July 2016.
The primary outcome measures were the Varma Constipation Severity Instrument overall score and obstructed defecation subscale score.
Of 317 patients evaluated, 95 (30.0%) had no internal intussusception, 126 (39.7%) had intra-rectal intussusception, and 96 (30.3%) had intra-anal intussusception. There was no association between rising grade of internal intussusception and either overall constipation score or obstructed defecation subscale score. Irritable bowel syndrome was associated with an increase in overall constipation score and obstructed defecation subscale score (40.5 ± 13.6 vs 36.0 ± 15.1, p = 0.007, and 22.3 ± 5.8 vs 20.0 ± 6.6, p < 0.001). Multivariate regression found irritable bowel syndrome and dyssynergia to be associated with a significant increase in obstructed defecation subscale scores.
The study was limited because it was an observational study from a single center.
Patients referred for surgical management of obstructive defecation syndrome should be screened and treated for irritable bowel syndrome and dyssynergia before considering surgical intervention. See Video Abstract at http://links.lww.com/DCR/A782.
尽管与便秘症状的相关性尚不明确，但最近出现了对内部套叠进行手术治疗的趋势。
本研究旨在描述梗阻性排便障碍综合征患者的便秘情况，并确定内部套叠或其他诊断（如肠易激综合征）是否可能导致这些症状。
从一个前瞻性维护的数据库中研究在盆底障碍中心接受评估的梗阻性排便患者。使用排粪造影术，根据牛津直肠脱垂分级对患者进行分类。还确定了共存疾病，如肠膨出、直肠膨出和协同失调。肠易激综合征的存在使用罗马 IV 标准定义，便秘严重程度使用瓦尔马便秘严重程度量表进行量化。
本研究在一家三级保健大学医疗中心（马萨诸塞州总医院）进行。
这项研究纳入了 2007 年 5 月至 2016 年 7 月期间进行排粪造影成像和完成便秘严重程度量表调查的 317 例连续患者。
主要观察指标是瓦尔马便秘严重程度量表的总体评分和梗阻性排便亚量表评分。
在评估的 317 例患者中，95 例（30.0%）无内部套叠，126 例（39.7%）有直肠内套叠，96 例（30.3%）有肛门内套叠。内部套叠程度的升高与便秘的总体评分或梗阻性排便亚量表评分均无关联。肠易激综合征与便秘的总体评分和梗阻性排便亚量表评分的增加相关（40.5±13.6 比 36.0±15.1，p=0.007；22.3±5.8 比 20.0±6.6，p<0.001）。多变量回归分析发现，肠易激综合征和协同失调与梗阻性排便亚量表评分的显著增加相关。
本研究的局限性在于它是一项来自单个中心的观察性研究。
在考虑手术干预之前，应筛查并治疗因手术治疗梗阻性排便障碍综合征而就诊的患者的肠易激综合征和协同失调。详见原文视频摘要，网址：http://links.lww.com/DCR/A782。
