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치골직장근 이완부전증 환자의 임상양상 및 바이오피드백 치료 성적

The Clinical Characteristics and Outcomes of Biofeedback Treatment for Patients with Nonrelaxing Puborectalis Syndrome

대한대장항문학회지 2006년 22권 3호 p.169 ~ 176
안은정 ( Ahn Eun-Jung ) - 이화여자대학교 의과대학 외과학교실

정규영 ( Jung Gyu-Young ) - 이화여자대학교 의과대학 외과학교실
천승희 ( Cheon Seung-Hui ) - 이화여자대학교 의과대학 외과학교실
이은정 ( Lee Eun-Joung ) - 이화여자대학교 의과대학 외과학교실
오수연 ( Oh Soo-Yoon ) - 건국대학교 의과대학 외과학교실
정순섭 ( Chung Soon-Sup ) - 이화여자대학교 의과대학 외과학교실
이령아 ( Lee Ryung-Ah ) - 이화여자대학교 의과대학 외과학교실
김광호 ( Kim Kwang-Ho ) - 이화여자대학교 의과대학 외과학교실
박응범 ( Park Eung-Bum ) - 이화여자대학교 의과대학 외과학교실

Abstract


Purpose: Biofeedback treatment is thought to be appropriate for patients with nonrelaxing puborectalis syndrome (NRPR). The aim of this study is to analyze the physiologic characteristics and to assess the outcomes of biofeedback treatment for patients with NRPR.

Methods: Forty-six (46) patients with NRPR were evaluated with anorectal physiologic studies, including colonic transit time (n=26), anorectal manometry (n=41), defecography (n=46), anal sphincter EMG (n=28), and colonoscopy or barium enema (n=33). The treatment consisted of a training program with EMG-based biofeedback for 30 minutes once a week and routine supportive care, including Kegel practice.

Results: The mean age was 52.8 years, and the sex ratio was 1 male to 0.6 female. A delayed colonic transit time was noted in 5 patients (19.26%). In the NRPR group, the maximal voluntary contraction and the mean squeezing pressure were higher than they were for other patients with pelvic outlet obstructive disease. Also, the perineal descents and the dynamic change of anorectal angle were shorter. Polyps were observed in 6 patients (18.2%), melanosis coli in 4 patients (12.1%), and diverticula in 3 patients (9.1%). The rectoanal inhibitory reflex (RAIR) was negative in 3 patients (7.3%). The patients underwent a mean of 4.0 sessions, and the mean follow-up was 7.4 months. Twenty-three (23) patients (82.1%) experienced improved of symptoms or EMG findings. The patients (17.9%) who did not improve had several abnormal findings: neuro-psychologic disease with delayed colonic transit time in 2 cases, negative RAIR in 2 cases, and melanosis coli in one case.

Conclusions: We think that biofeedback training is an effective treatment for patients with NRPR. In addition, several factors, such as neuro-psychologic diseases, delayed colonic transit time, negative RAIR, or melanosis coli may influence the prognosis for biofeedback treatment, so further large-scaled studies will be needed to confirm these findings. J Korean Soc Coloproctol 2006;22:169-176

키워드

바이오피드백 치료;치골직장근 이완부전증
Biofeedback treatment;Nonrelaxing puborectalis syndrome
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