用A型肉毒毒素治疗的成年患者的出口类型便秘:一个队列研究
Giuseppe Brisinda1,2, Valeria Fico3, Giuseppe Tropeano3
1Catholic School of Medicine, "Agostino Gemelli", 00168, Rome, Italy. giuseppe.brisinda@policlinicogemelli.it.
International journal of colorectal disease
|January 21, 2025
概括
甲型肉毒素注射改善了患有骨盆底疾病的患者的慢性便秘症状,通过放松 puborectalis 肌肉. 这种治疗导致便频率增加,并改善了直肠测量和缺陷检查结果.
科学领域:
- 胃肠病学 胃肠病学
- 结肠直肠手术 结肠直肠手术
- 盆地底疾病 盆地底疾病
背景情况:
- 慢性便秘是一种普遍的疾病,当与骨盆底疾病相关时,往往会构成治疗挑战.
- 生物反疗法是治疗骨盆底疾病的主要治疗方法,取决于现有的专业知识.
- 甲型肉毒毒素提供了一种药理方法,可以在便秘患者中选择性地削弱 puborectalis 肌肉和外部关节.
研究的目的:
- 评估A型肉毒毒素注射在治疗骨盆底功能障碍后的慢性便秘中的疗效.
- 评估肉毒毒素对直肠测量和排泄学参数的影响.
主要方法:
- 八十二名被诊断患有慢性出口阻塞便秘的患者接受了100个单位的A型肉毒素.
- 注射的目标是 puborectalis 肌肉和外部关节.
- 结果在2个月的随访期评估,使用症状评估,直肠测量和缺陷学.
主要成果:
- 69名患者 (84%) 在两个月内观察到症状改善.
- 发现每周便频率显著增加 (2.4至5.1,P<0.0001).
- 直肠测量显示,应力压力下降 (91~61mmHg,P<0.0001),而 defecography 显示,应力时直肠角度有所改善 (96°~124°,P<0.0001).
- 在8.5%的患者中发生轻度平坦性失禁.
结论:
- 甲型肉毒毒素有效放松 puborectalis 肌肉,导致慢性便秘患者的压力值降低和功能参数改善.
- 通过直肠超声波指导的注射是一种安全的程序.
- 为了维持临床益处,可能需要重复治疗.
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