国内外便秘诊治指南比较分析

刘宝华; 刘沂

doi:10.16016/j.1000-5404.201906038

您当前的位置：

首页 >

文章列表页 >

国内外便秘诊治指南比较分析

专家述评 | 更新时间：2026-01-09

- 国内外便秘诊治指南比较分析
- Comparison analysis between domestic and foreign guidelines on constipation diagnosis and treatment
- 第三军医大学学报 2019年41卷第19期页码：1845-1850
- 作者机构：
  
  1.400042 重庆，陆军军医大学(第三军医大学)大坪医院:普通外科, 全军便秘诊治中心
  2.400042 重庆，陆军军医大学(第三军医大学)大坪医院:信息科
- 作者简介：
  
  [刘宝华，博士，主任医师，教授，博士生导师。担任中国医师协会肛肠分会副会长，中国医师协会肛肠分会功能性疾病专业委员会主任委员，全军结直肠疾病专委会副主任委员。任十余家杂志常务编委和编委。获重庆市科技进步一等奖1项，全军医疗成果二等奖1项，重庆市科技进步二等奖2项。主编专著4部，副主编专著5部。以第一作者在国内外期刊发表论文100余篇。主要从事肛肠外科方面的研究。E-mail:LBH57268@163.comLIU Baohua, E-mail: LBH57268@163.com
- 基金信息：
  
  国家自然科学基金面上项目(81570483);国家自然科学基金面上项目(81770541);重庆市社会民生科技创新专项(CSTC2015shmszx120109)
- DOI：10.16016/j.1000-5404.201906038
  中图分类号： R574.62
- 收稿：2019-06-07，
  
  修回：2019-08-31，
  
  纸质出版：2019-10-15
- 稿件说明：
移动端阅览
刘宝华, 刘沂. 国内外便秘诊治指南比较分析[J]. 第三军医大学学报, 2019,41(19):1845-1850.

Baohua LIU, Yi LIU. Comparison analysis between domestic and foreign guidelines on constipation diagnosis and treatment[J]. Journal of Third Military Medical University, 2019, 41(19): 1845-1850.
刘宝华, 刘沂. 国内外便秘诊治指南比较分析[J]. 第三军医大学学报, 2019,41(19):1845-1850. DOI： 10.16016/j.1000-5404.201906038.

Baohua LIU, Yi LIU. Comparison analysis between domestic and foreign guidelines on constipation diagnosis and treatment[J]. Journal of Third Military Medical University, 2019, 41(19): 1845-1850. DOI： 10.16016/j.1000-5404.201906038.

摘要

对国内外“便秘诊治指南”的各自特点进行比较分析。阐述内容包括便秘的概念、发病率、分型及病因分类、诊断方法和治疗4个方面。便秘是一种发病率较高的疾病，老年人和患有其他各种疾病患者发病率更高；便秘分为结肠慢传输型、出口梗阻型和功能性排便障碍型等类型。病因分为功能性疾病、器质性疾病和药物3类。对便秘患者行全面检查有利于了解便秘的病因和分型，以指导精准的治疗；应重视便秘患者的结肠镜检查，易于发现其结直肠息肉和器质性病变。便秘的非手术治疗包括健康教育、饮食的调节、排便习惯的建立、药物的分级应用。结肠慢传输型便秘手术方法包括次全结肠切除盲肠直肠吻合术、全结肠切除回肠直肠吻合术、结肠旷置术、回肠造口术。对于出口梗阻型便秘中的直肠内脱垂，目前国外多采用腹腔镜腹侧补片直肠悬吊术；直肠前突手术方法包括经阴道和经肛手术。

Abstract

We compared and analyzed the guidelines at home and abroad on constipation diagnosis and treatment

and elucidated its concept

incidence and classification

as well as its etiology classification

diagnosis and treatment methods. Currently

constipation is considered as a disease with higher incidence

especially in the elderly and the patients with multiple comorbidities. Constipations are concisely classified as colonic slow transit constipation

outlet obstruction constipation and functional defecation disorders. According to its etiology

constipations are divided into 3 categories: functional disease

organic disease and drug-induced disease. Comprehensive examinations of constipation are helpful to understand its etiology and classification and to guide accurate treatment. Colonoscopy is valuable in the detection of polyp and organic disease of colonic rectum in constipation patients. Nonsurgical treatments are very important for constipation

including health education

dietary regulation

establishment of bowel habits

and graded use of drug. The surgical methods for slow transit constipation include subtotal colectomy with cecoproctostomy

total colectomy with ileoproctostomy

colonic exclusion and ileostomy. Laparoscopic ventral mesh rectal suspension is commonly performed abroad to treat internal rectal prolapse of outlet obstruction constipation. Transvaginal and transanal approaches are used for the surgical treatment of rectocele. In the treatment of constipation

health education and non-surgical treatments should be emphasized. Surgical treatment must be considered only after the systematic non-surgical treatments are ineffective or not effective.

关键词

Keywords

references

德罗斯曼.罗马Ⅳ: 功能性胃肠病肠-脑互动异常[M].方秀才, 侯晓华, 译.北京: 科学出版社, 2016: 642-654, 818-831.

DROSSMAN D A. Rome Ⅳ: Functional Gastrointestinal Disorders/Disorders of Gut-Brain Interaction[M]. FANG X C, HOU X H, Translator. Beijing: Science Press, 2016: 642-654, 818-831.

PAQUETTE I M, VARMA M, TERNENT C, et al . The American society of colon and rectal surgeons' clinical practice guideline for the evaluation and management of constipation[J ] . Dis Colon Rectum, 2016, 59(6): 479-492. DOI:10.1097/dcr.0000000000000599.

KROGH K, CHIARIONI G, WHITEHEAD W. Management of chronic constipation in adults[J]. United Eur Gastroenterol J, 2017, 5(4): 465-472. DOI:10.1177/205064061666 3439.

LINDBERG G, HAMID S S, MALFERTHEINER P, et al . World gastroenterology organisation global guideline: constipation: a global perspective[J ] . J Clin Gastroenterol, 2011, 45(6): 483-487. DOI:10.1097/MCG.0b013e31820fb914.

[中华医学会消化病学分会胃肠动力学组, 中华医学会外科学分会结直肠肛门外科学组.中国慢性便秘诊治指南(2013年, 武汉)[J ] .中华消化杂志, 2013, 33(5): 291-297. DOI: 10.3760/cma.j.issn.0254-1432.2013.05.002 http://dx.doi.org/10.3760/cma.j.issn.0254-1432.2013.05.002 .

[Gastrointestinal Dynamics Group, Society of Digestive Diseases, Chinese Medical Association. Colorectal and Anorectal Surgery Group, Surgical Society of Chinese Medical Association. Guidelines for the diagnosis and treatment of chronic constipation in China (Wuhan, 2013)[J ] . Chin J Digestion, 2013, 33(5): 291-297. DOI: 10.3760/cma.j.issn.0254-1432.2013.05.002 http://dx.doi.org/10.3760/cma.j.issn.0254-1432.2013.05.002 .

中国医师协会肛肠医师分会.便秘外科诊治指南(2017)[J].中华胃肠外科杂志, 2017, 20(3): 241-243.

Anorectal Physicians Branch of Chinese Medical Association. Guidelines for diagnosis and treatment of constipation surgery (2017)[J]. Chin J Gastrointest Surg, 2017, 20(3): 241-243.

郑松柏, 姚健凤, 张颖.老年人慢性便秘的评估与处理专家共识[J].中华老年病研究电子杂志, 2017, 4(2): 7-15.

ZHENG S B, YAO J F, ZHANG Y. Expert consensus on Evaluation and management of chronic constipation in the elderly[J]. Chin J Geriatr Res Electron Ed, 2017, 4(2): 7-15.

中国中西医结合学会消化系统疾病专业委员会.功能性便秘中西医结合诊疗共识意见(2017)[J].中国中西医结合消化杂志, 2018, 26(1):18-26. DOI:10.3969/j.issn.1671-038X.2018.01.03.

Professional Committee on Digestive System Diseases of Chinese Society of Integrated Traditional Chinese and Western Medicine. Consensus on diagnosis and treatment of functional constipation by integrated traditional chinese and western medicine (2017)[J]. Chin J Integ Trad West Med Diges. 2018, 26(1):18-26. DOI:10.3969/j.issn.1671-038X.2018.01.03.

王垂杰.功能性便秘诊疗指南[J].中国中医药现代远程教育,2011, 9(17): 127-128.

WANG C J. Guidelines for the diagnosis and treatment of functional constipation[J]. Chin Med Mod Distance Educ China, 2011, 9(17): 127-128.

中华中医药学会脾胃病分会.便秘中医诊疗专家共识意见(2017)[J].中医杂志, 2017, 58(15):1345-1350. DOI: 10.13288 /j.11-2166 /r.2017.15.023.

Spleen and Stomach Diseases Branch of Chinese Society of Traditional Chinese Medicine.Expert consensus on TCM diagnosis and treatment of constipation (2017)[J]. J Traditi Chin Med, 2017, 58(15):1345-1350. DOI: 10.13288 /j.11-2166 /r.2017.15.023.

SHIN J E, JUNG H, LEE T H, et al . Guidelines for the diagnosis and treatment of chronic functional constipation in Korea, 2015 revised edition[J ] . J Neurogastroenterol Motil, 2016, 22(3): 383-411. DOI:10.5056/jnm15185.

INDONESIAN SOCIETY OF GASTROENTEROLOGY (ISG). National consensus on the management of constipation in Indonesia 2010[J]. Acta Med Indones, 2011, 43(4): 267-274.

LARKIN P J, SYKES N P, CENT ENO C, et al . The management of constipation in palliative care: clinical practice recommendations[J ] . Palliat Med, 2008, 22(7): 796-807. DOI:10.1177/0269216308096908.

MÜLLER-LISSNER S, BASSOTTI G, COFFIN B, et al . Opioid-induced constipation and bowel dysfunction: A clinical guideline[J ] . Pain Med, 2017, 18(10): 1837-1863. DOI:10.1093/pm/pnw255.

RAO S S C, BENNINGA M A, BHARUCHA A E, et al . ANMS-ESNM position paper and consensus guidelines on biofeedback therapy for anorectal disorders[J ] . Neurogastroenterol Motil, 2015, 27(5): 594-609. DOI:10.1111/nmo.12520.

MAEDA Y, O'CONNELL P R, LEHUR P A, et al . Sacral nerve stimulation for faecal incontinence and constipation: a European consensus statement[J ] . Colorectal Dis, 2015, 17(4): O74-O87. DOI:10.1111/codi.12905.

GREENWALD B J. Clinical practice guidelines for pediatric constipation[J]. J Am Acad Nurse Pract, 2010, 22(7): 332-338. DOI:10.1111/j.1745-7599.2010.00517.x.

TABBERS M M, DILORENZO C, BERGER M Y, et al . Evaluation and treatment of functional constipation in infants and child ren[J ] . J Pediatr Gastroenterol Nutr, 2014, 58(2): 265-281. DOI:10.1097/mpg.0000000000000266.

National Collaborating Centre for Women's and Children's Health (UK). Constipation in Children and Young People: Diagnosis and Management of Idiopathic Childhood Constipation in Primary and Secondary Care[M]. London: RCOG Press, 2010.

WEINLAND S R, MORRIS C B, HU Y M, et al . Characterization of episodes of irritable bowel syndrome using ecological momentary assessment[J ] . Am J Gastroenterol, 2011, 106(10): 1813-1820. DOI:10.1038/ajg.2011.170.

刘宝华.慢性便秘与结直肠肿瘤的相关性[J].中华胃肠外科杂志, 2017, 20(3): 255-257. DOI:10.3760/cma.j.issn.1671-0274.2017.03.005.

LIU B H, Correlation between chronic constipation and colorectal neoplasms[J]. Chin J Gastrointest Surg, 2017, 20(3): 255-257. DOI:10.3760/cma.j.issn.1671-0274.2017.03.005.

刘宝华, 魏东, 杨向东, 等.不同术式对慢传输型便秘患者的疗效、营养和健康状况的影响[J].第三军医大学学报, 2013, 35(21): 2265-2269. DOI:10.16016/j.1000-5404.2013.21.024.

LIU B H, WEIDONG, YANG X D, et al . Effect of different operative approaches on efficiency, and nutritional and health status of slow transit constipation patients[J ] . J Third Mil Med Univ, 2013, 35(21): 2265-2269. DOI:10.16016/ j.1000-5404.2013.21.024.

代全武, 喻家菊, 兰明银, 等.结肠旷置术治疗顽固性慢传输型便秘[J].中华胃肠外科杂志, 2003, 6(6): 394-396.

DAI Q W, YU J J, LAN M Y, et al . Study of the colonic exclusion on intractable slow transit constipation[J ] . Chin J Gastrointest Surg, 2003, 6(6): 394-396.

魏东, 张远耀, 蔡建, 等.结肠旷置逆蠕动盲直肠吻合术治疗老年慢传输型便秘[J].实用医药杂志, 2009, 26(8): 10-12. DOI:10.14172/j.cnki.issn1671-4008.2009.08.028.

WEI D, ZHANG Y Y, CAI J, et al . Clinical studies on the results of chronic slow-transit constipation treated by colonic exclusion therapy and antiperistaltic cecoproctostomy[J ] . Pract J Med Pharm, 2009, 26(8): 10-12. DOI:10.14172/j.cnki.issn1671-4008.2009.08.028.

彭波, 吴磊, 江从庆, 等.结肠慢传输型便秘的外科治疗[J].腹部外科, 2009, 22(6): 374-375.

PENG B, WU L, JIANG C Q, et al . Surgical treatment of slow transit constipation of colon[J ] . J Abdom Surg, 2009, 22(6): 374-375.

D'HOORE A, CADONI R, PENNINCKX F. Long-term outcome of laparoscopic ventral rectopexy for total rectal prolapse[J]. Br J Surg, 2004, 91(11): 1500-1505. DOI:10.1002/bjs.4779.

WIJFFELS N A, COLLINSON R, CUNNINGHAM C, et al . What is the natural history of internal rectal prolapse?[J ] . Color Dis, 2009, 12(8): 822-830. DOI:10.1111/j.1463-1318.2009.01891.x.

VAN IERSEL J J, PAULIDES T J C, VERHEIJEN P M, et al . Current status of laparoscopic and robotic ventral mesh rectopexy for external and internal rectal prolapse[J ] . World J Gastroenterol, 2016, 22(21): 4977. DOI:10.3748/wjg.v22.i21.4977.

EMILE S H, ELFEKI H A, YOUSSEF M, et al . Abdominal rectopexy for the treatment of internal rectal prolapse: a systematic review and meta-analysis[J ] . Colorectal Dis, 2017, 19(1): O13-O24. DOI:10.1111/codi.13574.

浏览量

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

高海拔特殊环境驻地官兵功能性便秘的流行病学调查与综合防控策略构建

复方嗜酸乳杆菌片对便秘的治疗作用及对肠道菌群的影响

先天性肛门闭锁伴直肠舟状窝瘘术后便秘原因的临床研究

结肠传输试验在慢传输型便秘诊断中的应用

肛门直肠测压在便秘诊断中的作用