치골직장근 이완 부전증의 바이오피드백 치료에 대한 중기 추적검사 및 결과 예보지표 분석
Outcome and Prognostic Factors Associated with Poor Outcome of Biofeedback Therapy for Constipated Patients with Non- relaxing Puborectalis Syndrome
백순만, 김남혁, 황용희, 김경래, 최건필,
소속 상세정보
백순만 ( Baek Soon-Man )
서울위생병원 외과
김남혁 ( Kim Nam-Hyuk )
서울위생병원 외과
황용희 ( Hwang Yong-Hee )
서울위생병원 외과
김경래 ( Kim Kyung-Rae )
고려대학교 구로병원 외과
최건필 ( Choi Gun-Phil )
서울위생병원 외과
KMID : 0356720030190020074
Abstract
Purpose: Biofeedback is a major treatment method for constipated patients with non-relaxing puborectalis syndrome. However a significant percent of patients still showed poor outcome, and little has been known about the predictors associated with outcome of biofeedback. The aim of this study was to determine the outcome and identify predictors associated with poor outcome of biofeedback therapy for constipated patients with non-relaxing puborectalis syndrome.
Methods: Fifty-two constipated patients with non-relaxing puborectalis syndrome (median age, 47 years) who had more than one biofeedback session after defecography were evaluated by standardized questionnaire, before, immediately after treatment, and at follow-up. Clinical bowel symptoms and anorectal physiological studies were analyzed. Any differences in demographics, clinical symptoms, and parameters of anorectal physiological study were evaluated between success group (patients felt improvement in symptoms at follow-up) and failure group (patients felt no improvement).
Results: Follow up (mean follow-up; 17 months) results were evaluated by an independent observer in 45 patients. At post-biofeedback, 42 (81 percents) patients felt improvement in symptoms, including 7 (13 percents) with complete symptom relief. At follow-up, 25 (56 percents) patients felt improvement in symptoms, including 1 (2 percents) with complete symptom relief. There was a significant reduction in difficult defecation (from 81 to 44, 53 percent, from pre-biofeedback to post-biofeedback, and at follow up respectively; P < 0.005, P < 0.01), sensation of incomplete defecation (from 90 to 50, 40 percent; P < 0.00001, P < 0.000005), laxative use (from 25 to 10, 11 percent; P < 0.05), and enema use
(from 13 to 0, 2 percent; P < 0.01, P < 0.05). Normal spontaneous bowel movement was increased from 42 percent pre-biofeedback to 81 percent post-biofeedback (P < 0.0001), 80 percent at follow up (P < 0.0005). Pre-biofeedback presence of symptoms of bowel habit change predict poor outcome (15 vs. 0 percent; failure vs. success, P＜0.05). High pressure zone in prebiofeedback manometry was longer in failure group than in success group (2.80 vs 2.01 cm, P < 0.05). In the success group, 11 (44 percent) had a rectocele, 1 (4 percent) had a rectal intussussception, 18 (72 percent) had a descending perineal syndrome, and 3 (12 percent) had a sigmoidocele. In the failure group, 4 (20 percent) had a rectocele, and 1 (5 percent) had a rectal intussusception, 14 (70 percent) had a descending perineal syndrome, and a sigmoidocele was not accompanied (P > 0.05). Accompanied rectocele, rectal intussusception, descending perineal syndrome, and sigmoidocele did not influence outcome.
Conclusion: Biofeedback is an effective option and should be considered as the first line therapy. Bowel habit change and long high pressure zone in pre-biofeedback manometry were predictors associated with poor outcome of biofeedback therapy for constipated patients with non-relaxing puborectalis syndrome.
키워드
치골직장근 이완 부전증;바이오피드백 치료;배변습관 변화;고압력대
Non-relaxing puborectalis syndrome;Biofeedback;Bowel habit change;High pressure zone
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