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직장류 환자에 대한 바이오피드백 치료

Biofeedback Therapy for Patients with Rectocele

대한대장항문학회지 2001년 17권 2호 p.69 ~ 75
김봉수 ( Kim Bong-Soo ) - 서울위생병원 외과

황용희 ( Hwang-Young-Hee ) - 서울위생병원 일반외과
최건필 ( Choi Gun-Phil ) - 서울위생병원 일반외과

Abstract


Purpose: The aim of this study was to determine the outcome and identify predictors of success of biofeedback therapy for rectocele.

Methods: Twenty four female patients (mean age 43.8 years) with rectal emptying difficulties and a rectocele greater than 2 cm at defecography were evaluated beforehand with a standardized questionnaires, immediately after biofeedback therapy, and at follow up. Defecography, manometry, colon transit studies and electrophysiology were also analyzed.

Results: Follow up (mean 7.2; range 2∼17 months) results were evaluated by an independent observer in 20 patients. At the end of biofeedback, 22 (92 percent) patients felt improvement in symptoms, including 13 (54 percent) with symptomatic relief. At follow-up, 14 (70 percent) patients felt improvement in symptoms, including 3 (15 percent) with complete relief of symptoms. There was a significant reduction in difficult defecation (from 79 to 29, 40 percent, from pre-biofeedback to post-biofeedback, at follow-up respectively; P<0.001, P<0.05), sensation of incomplete defecation (from 96 to 46, 60 percent; P<0.001, P<0.005), laxative use (from 54 to 25, 30 percent; P<0.05), enema use (from 21 to 0,0 percent; P<0.05), anal pain (from 21 to 0, 5 percent; P<0.05) and digitation (from 21 to 4, 5 percent). Normal spontaneous bowel movement was significantly increased from 50 percent pre-biofeedback to 83 post-biofeedback (P<0.05), 65 percent at follow-up. Abdominal pain (P<0.05) and digitation (P<0.05) related to poor results. High mean squeeze pressure (P<0.001) and high maximum squeeze pressure (P<0.05) on pre-biofeedback manometry were also related to a poor outcome. Age, duration of symptoms, parity, number of sessions of biofeedback, gynecologic surgery history, and rectocele size at defecography had no prognostic value. Anismus and colonic inertia did not influence the outcome of biofeedback.

Conclusion: Biofeedback is an effective treatment option for patients with obstructed defecation due to rectocele.

키워드

직장류;변비;골반출구폐쇄;대장무력증
Rectocele;Constipation;Biofeedback;Anismus;Colonic inertia
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