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골반출구폐쇄 환자에 대한 바이오피드백 치료 실패의 예후인자 분석

Prognostic Factors Associated with Poor Outcome of Biofeedback Therapy for Constipated Patients with Pelvic Outlet Obstruction

대한대장항문학회지 2008년 24권 5호 p.313 ~ 321
김성진 ( Kim Sung-Jin ) - 서울위생병원 외과

황용희 ( Hwang Yong-Hee ) - 서울위생병원 외과
정용환 ( Jung Yong-Hwan ) - 서울위생병원 외과

Abstract


Purpose: The aim of this study was to identify the prognostic factors associated with poor outcome of biofeedback therapy.

Methods: One hundred thirty-seven (137) constipated patients with pelvic outlet obstruction (median age 49 years) had more than one biofeedback session after defecography. Follow-up data (mean follow-up: 14 months; range: 2∼37 months) were obtained in 114 patients. Any differences in demographics, clinical symptoms, and parameters of an anorectal physiological study were evaluated between the success group and the failure group.

Results: At follow-up, 80 (70 percent) patients felt improvement in symptoms, but 34 (30 percent) patients did not. Pre-biofeedback presence of symptoms of difficult defecation predict poor outcome (88 vs. 69 percent for failure vs. success, P<0.05). The positive and the negative predictive values of difficult defecation for poor outcome were 35 percent and 86 percent, respectively. A negative mean pressure change on pre-biofeedback anal manometry was related to a poor outcome (65 vs. 26 percent for failure vs. success, P<0.001). The positive and the negative predictive values of negative mean pressure change for poor outcome were 51 percent and 83 percent, respectively. A negative electrical current change on pre-biofeedback anal electromyography was related to a poor outcome (23 vs. 9 percent for failure vs. success, P<0.05). The positive and the negative predictive values of negative electrical-current change for poor outcome were 53 percent and 74 percent, respectively.

Conclusions: Difficult defecation, negative mean pressure change in pre-biofeedback anal manometry, and negative electrical current change in pre-biofeedback anal electromyography were predictors associated with poor outcome of biofeedback therapy for constipated patients with pelvic outlet obstruction. J Korean Soc Coloproctol 2008;24:313-321

키워드

골반출구폐쇄;바이오피드백 치료;만성변비
Pelvic outlet obstruction;Biofeedback;Constipation
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