Objective To explore the effect of triple viable bifidobacterium lactobacillus tablets combined with polyethylene glycol 4000 on elderly patients with chronic constipation. Methods This pilot study was conducted at the Center of Gerontology and Geriatrics, West China Hospital. A total of 120 patients with chronic constipation, aged 60 years or older, treated between April 2015 and April 2016 were enrolled, and randomly assigned into group A (polyethylene glycol 4000) and group B (triple viable bifidobacterium lactobacillus tablets combined with polyethylene glycol 4000) with 60 patients in each. All the patients were estimated before and after the treatment with Bristol Stool Form Scale (BSFS), Patient Assessment of Constipation Symptom (PAC-SYM) and Constipation Related Disability (CRDS), and the adverse drug reactions were observed. Results In group A, before the treatment, the scores of BSFS, PAC-SYM and CRDS were 1.98±0.77, 37.87±4.12 and 31.03±3.19, respectively; while after the treatment, the scores were 3.87±0.82, 28.55±2.15 and 18.56±1.80, respectively, which were all significantly improved (P<0.05). In group B, before the treatment, the scores of BSFS, PAC-SYM and CRDS were 2.03±0.78, 36.25±4.98 and 30.28±3.56, respectively; while after the treatment, the scores were 4.80±0.75, 19.73±3.42 and 13.80±2.36, respectively, which were all significantly improved (P<0.05). The improvement of constipation in group B was significantly better than that in group A after treatment (P<0.05). There was no adverse drug reaction observed. Conclusion Triple viable bifidobacterium lactobacillus tablets combined with polyethylene glycol 4000 may be an effective therapy for elderly patients with chronic constipation.
Objective To assess the efficacy and safety of Chinese herbal medicines for chronic functional constipation. Methods We searched CNKI (1989 to November, 2009), CBM (1989 to November, 2009), VIP (1989 to November, 2009), Cochrane Library (Issue 4, 2009), PubMed (1966 to November, 2009) and EMbase (1986 to November, 2009). All randomized and quasi-randomized clinical trials of treating chronic functional constipation with Chinese herbal medicines versus untreated, placebo or western drug groups were included. Data were extracted independently by two reviewers. The methodological quality of trials was evaluated with Cochrane Handbook 5.0.2 criteria. Meta-analyses were conducted by the RevMan 5.0 software. Results Twenty-one trials involving 2 602 patients were included. The Meta-analysis results showed that: Chinese herbal medicines improved both syndromes and colonic transit function of recipients; moreover, it is superior to both gastrointestinal prokinetic agent in effective rate (RR=1.18, 95%CI 1.12 to 1.25), healing rate (RR=1.59, 95%CI 1.35 to 1.88), and cathartic in effective rate (RR=1.18, 95%CI 1.10 to 1.27), healing rate (RR=1.16, 95%CI 1.29 to 2.10). Integration of Chinese herbal medicines and gastrointestinal prokinetic agent is superior to gastrointestinal prokinetic agent in effective rate (RR=1.21 95%CI 1.09 to 1.34) and healing rate (RR=1.41, 95%CI 1.11 to 1.79). Conclusion Some Chinese herbal medicines may be effective and safe in treating chronic functional constipation, which can not be bly proved at present for lack of studies with high quality.
ObjectiveTo explore etiopathogenesis of slow transit constipation(STC). MethodsThe model of rat with “cathartic colon” was established, and the changes of colonic electromyography of the rat was examined. ResultsThe frequency and amplitude of slow wave in vivo of rats with cathartic colon was decreased markedly. Postmeal spike potential and duration was decreased, showing that gastrocolonic reflex of rats colon was decreased.ConclusionLong term abuse of stimulant laxuatives could damage enteric nervous system and accelerate the pathological changes of STC.
ObjectiveTo evaluate the functional outcomes and quality of life in patients with surgery for slow transit constipation (STC).MethodsFrom March 2013 to July 2017, 29 patients undergoing total or subtotal colectomy for STC in our department were analyzed prospectively. Their preoperative and postoperative 1-year follow-up details were analyzed. Evacuation function of all patients was assessed by bowel movements, abdominal pain, bloating, straining, laxative, enema use and the Wexner constipation scales. Quality of life was evaluated by the Gastrointestinal Quality of Life Index (GIQLI) and the short-form (SF)-36 survey.ResultsA high number of patients (93.1%, 27/29) in STC stated that surgery received benefits to their health. Compared with that before operation, the number of bowel movements per week during a 1-year follow-up increased significantly (31.6±19.9 vs. 1.21±0.6, P<0.05). Significant trends toward improvement of bloating, straining, laxative and enema use were noted 1-year following surgery (P<0.05). The Wexner constipation scales scores during a 1-year follow-up decreased significantly (5.69±3.4 vs. 20.34±0.6, P<0.05). The GIQLI scores during a 1-year follow-up increased significantly (120.7±20.4 vs. 78.6±17.3, P<0.05). Moreover, results of SF-36 showed significant improvements in 7 spheres (role physical, role emotional, physical pain, vitality, mental health, social function and general health) during a 1-year follow-up compared with those before operation (P<0.05).ConclusionTotal or subtotal colectomy for STC did not only alleviate constipation symptoms dramatically, but also received significant improvements in the patients’ quality of life.
Objective Both stapled transanal rectal resection (STARR) and vaginal bridge repair are new operative techniques for treatment of rectocele transanal and transvaginal, respectively. In this study we observe the clinical outcomes for STARR as compared with vaginal bridge repair procedure. Methods The clinical data of 31 patients with obstructive defecation syndrome from January 2007 to May 2009 were retrospectively analyzed. The patients were divided into 2 groups according to different operative approach: STARR group (n=18) and bridge repair suture group (n=13). The clinical outcomes observed were operative time, blood loss, length of stay, cost of hospitalization, complication and the improvement of obstructed defecation syndrome. Results There was no difference in the age and severity in the patients of two groups. Evaluation of the clinical outcomes showed 16 (88.9%) patients in the STARR group and 6 (46.2%) in the bridge repair suture group reported improvement in symptoms (P=0.017). STARR had a shorter operative time (24.6 min vs. 33.2 min， Plt;0.01), less estimated blood loss (3.9 ml vs. 16.2 ml， Plt;0.01), more costly (10 743 yuan vs. 3 543 yuan, Plt;0.01) and a higher anal incontinenc rate but reversible. The length of stay was similar (average 6 d). Conclusion The stapled transanal rectal resection procedure is more superior to the vaginal bridge repair suture for improvement of obstructed defecation syndrome from rectocele, however, it has a higher cost and some patient with reversible slight anal incontinence after surgery.
Objective To investigate the current status of constipation during postoperative hospitalization and the factors associated with moderate to severe constipation at discharge in lung cancer patients. Methods Lung cancer patients who underwent surgery in 6 tertiary hospitals in Sichuan Province from November 2017 to January 2020 were enrolled. The MD Anderson Symptom Scale-Lung Cancer Module was used to collect postoperative constipation scores. Unconditional logistic stepwise regression was used to analyze the related influencing factors for moderate to severe constipation on the day of discharge. Results Finally 337 patients were collected. There were 171 males and 166 females, with an average age of 55.0±10.3 years. Constipation scores of lung cancer patients increased from postoperative day 1 to day 3, and showed a decreasing trend from day 3 to day 7. Moderate to severe constipation was present in 68 (20.2%) patients at discharge. The postoperative hospital stay (OR=0.743, P<0.001) and the dose of morphine used during postoperative hospitalization (OR=1.002, P=0.015) were influencing factors for moderate to severe constipation at discharge in lung cancer patients. ConclusionLung cancer patients have the most severe constipation on postoperative day 3. Moderate to severe constipation at discharge is associated with the postoperative hospital stay and the dose of morphine used during postoperative hospitalization.
目的总结结肠冗长症合并结直肠癌的临床病理特征，并文献复习结肠冗长症与结直肠癌的关系。 方法回顾性分析兰州大学第一医院普外一科2011年1月至2012年12月期间收治的17例结肠冗长症合并结直肠癌患者的临床资料。 结果184例结直肠癌患者中合并结肠冗长症17例（9.24%），合并家族性息肉病恶变2例（1.09%），合并遗传性非息肉病性结直肠癌1例（0.54%），合并炎症性肠病1例（0.54%）。合并结肠冗长症的比例较高（P＜0.05）。其中术前经结肠气钡灌肠检查诊断为结肠冗长症5例，术中诊断为结肠冗长症12例。所有患者均行手术治疗，切除结肠13～80 cm，平均33.8 cm。术后发生肺部感染、切口液化1例，腹水1例，肠瘘1例，骶前感染1例。术后17例患者均获随访，随访时间6～12个月，中位数为10个月。随访期间，1例患者于术后1年出现卵巢转移。 结论结肠冗长症合并顽固性便秘可能是结直肠癌发病的高危因素。