| 摘要 |
Pelvic outlet obstruction is one of causes of idiopathic constipation. Theree treatments, including local anesthesia of the anal sphincters and puborectalis, posterior division of the puborectalis, and biofeedback training of the anal sphincters and pelvic floor muscles, have been proposed. The purpose of this study is to compare the clinical results of these three managements. Eighty diagnosed into three groups. Group I patients (20 cases) were injected with 8 ng botulinum A toxin, 4 ng into each side of the puborectalis and external anal sphincter muscles. Group II patients (20 cases) received a posterior myectomy of anal internal sphincter and puborectalis. In group III (40 cases), the patients were taught how to relax anal sphincters and pelvic floor muscles during defecation using a biofeedback training program. The degree of satisfactory defecation, frequency of bowel movement, colon transit time, balloon expulsion test, anorectal angle, anal canal pressure, rectal compliance, and electromyography of the anal sphincters and puborectalis were all evaluated after complete treatment in all patients. In group I, the constipation complaints improved significantly in all patients. However, they trturned to the pretreatment condition 5 weeks later. In group II, 85% of the patients had an obvious improvement in their constipation complaint, but ten of them had the complication of varying degrees of stool incontinence. In group III, 88% of the patients had rather satisfactory improvement in their complaint, with no complications. Based on the results, we conclude that biofeedback training of the anal sphincters and pelvic floor muscles is the best method for treating pelvic outlet obstruction-type constipation. |
