Karasick S, Ehrlich S M
Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA.
AJR Am J Roentgenol. 1996 Jan;166(1):63-6. doi: 10.2214/ajr.166.1.8571906.
The purpose of this study was to determine whether constipation is a disorder of defecation or of impaired motility by using defecography and transit studies.
Thirty-five patients (34 women, one man) with severe constipation underwent defecography and colonic transit studies in a 2-month period. Transit studies included the use of orally administered radiopaque markers and plain abdominal radiographs obtained up to 4 days later. Fluoroscopically guided defecography was performed with barium paste introduced into the rectum.
Normal colonic transit time was observed in seven (20%) of the 35 patients. Abnormal findings included colonic inertia in six (17%) patients, hindgut dysfunction in 10 (29%) patients, and outlet obstruction in 12 (34%) patients. Rectocele, enterocele, descending perineum syndrome, and dyskinetic puborectalis were found equally in both groups of patients. Rectal prolapse was more commonly found in patients with hindgut dysfunction and outlet obstruction (p < .05).
Surgical or medical management of severely constipated patients relies on objectively identifying the underlying pathophysiology. Our findings suggest that constipation is often a disorder of defecation rather than an impairment of colonic motility.
本研究旨在通过排粪造影和传输研究来确定便秘是排便障碍还是动力受损。
35例（34名女性，1名男性）严重便秘患者在2个月内接受了排粪造影和结肠传输研究。传输研究包括口服不透X线标志物，并在4天后拍摄腹部平片。在荧光镜引导下，将钡糊剂注入直肠进行排粪造影。
35例患者中有7例（20%）结肠传输时间正常。异常表现包括6例（17%）患者结肠惰性，10例（29%）患者后肠功能障碍，12例（34%）患者出口梗阻。直肠膨出、肠膨出、会阴下降综合征和耻骨直肠肌运动障碍在两组患者中均有发现。直肠脱垂在有后肠功能障碍和出口梗阻的患者中更为常见（p < 0.05）。
严重便秘患者的手术或药物治疗依赖于客观地确定潜在的病理生理学。我们的研究结果表明，便秘通常是一种排便障碍，而非结肠动力受损。
