• 第二軍醫(yī)大學(xué)長海醫(yī)院普外科（上海200433）;

1概述
便秘是很常見的癥狀，在美國便秘的發(fā)生率為2%，英國為10%，日本為4%，我國天津為4.4%［1］，女性發(fā)病概率是男性的3倍。多數(shù)便秘患者可經(jīng)藥物治療治愈或改善癥狀，少數(shù)為難治性。少數(shù)便秘患者經(jīng)手術(shù)治療效果較好。便秘不是一種病，而是多種疾病的一個癥狀，不同的患者有不同的含義，包括： ①大便量少、硬，排出困難； ②排便困難合并一些特殊的癥候群，如長期用力排便、直腸脹感、排便不完全或依靠手法幫助排便； ③7天內(nèi)排便次數(shù)少于2～3次。臨床上常診斷為慢性頑固性便秘或特發(fā)性便秘，但其確切含義很難描述。“慢性”意指病史至少2年，或年幼時就發(fā)病； “特發(fā)性”說明我們對便秘的原因及流行病學(xué)了解不全面； “頑固性”意指經(jīng)一般藥物及非手術(shù)治療很難奏效，常需手術(shù)治療［2］。

引用本文： 喻德洪,金黑鷹. 慢性非特異性便秘診治的若干問題. 中國普外基礎(chǔ)與臨床雜志, 2003, 10(3): 207-208. doi: 復(fù)制

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2. Ackermann C. Constipation: medical and surgical management. In: Marti MC, Givil IC. Surgical management of anorectal and colonic diseases [M]. 2nd ed. Berlin: SpringVerlag, 1998∶331～337.
3. Pemberton JH, Rath DM, Ilstrup DM. Evaluation and surgical treatment of severe chronic constipation [J]. Ann Surg, 1991; 124(4)∶403.
4. Voderholzer WA, Wiebecke B, Gerum M, et al. Dysplasia of the submucous nerve plexus in slowtransit constipation of adults [J]. Eur J Gastroenterol Hepatol, 2000; 12(7)∶755.
5. Wedel T, Roblick UJ, Ott V, et al. Oligoneuronal hypoganglionosis in patients with idiopathic slowtransit constipation [J]. Dis Colon Rectum, 2002; 45(1)∶54.
6. ElSalhy M, Norrgard O, Spinnell S. Abnormal colonic endocrine cells in patients with chronic idiopathic slowtransit constipation [J]. Scand J Gastroenterol, 1999; 34(10)∶1007.
7. ElSalhy M, Norrgard O. Colonic neuroendocrine peptied levels in patients with chronic idiopathic slow transit constipation [J]. Ups J Med Sci, 1998; 103(3)∶223.
8. MitoloChieppa D, Mansi G, Rinaldi R, et al. Cholinergic stimulation and nonadrenergic, noncholinergic relaxation of human colonic circular muscle in idiopathic chronic constipation [J]. Dig Dis Sci, 1998; 43(12)∶2719.
9. Tomita R, Fujisaki S, Ikeda T, et al. Role of nitric oxide in the colon of patients with slowtransit constipation [J]. Dis Clolon Rectum, 2002; 45(5)∶ 593.
10. Pluta H, Bowes KL, Jewell LD. Longterm results of total abdominal colectomy for chronic idiopathic constipation [J]. Dis Colon Rectum, 1996; 39(2)∶160.
11. Fasth S,Hedlund H, Svaninger G, et al. Functional results after subtotal colectomy and caecorectal anastomosis [J]. Acta Chir Scand, 1983; 149(6)∶623.
12. Vasilevsky CA, Nemer FD, Balcos EG, et al. Is subtotal colectomy a viable option in the management of chronic constipation? [J]. Dis Colon Rectum, 1988; 31(9)∶679.
  1. 1. 喻德洪. 現(xiàn)代肛腸外科學(xué) [M]. 北京： 人民軍醫(yī)出版社， 1997∶472～477.
  2. 2. Ackermann C. Constipation: medical and surgical management. In: Marti MC, Givil IC. Surgical management of anorectal and colonic diseases [M]. 2nd ed. Berlin: SpringVerlag, 1998∶331～337.
  3. 3. Pemberton JH, Rath DM, Ilstrup DM. Evaluation and surgical treatment of severe chronic constipation [J]. Ann Surg, 1991; 124(4)∶403.
  4. 4. Voderholzer WA, Wiebecke B, Gerum M, et al. Dysplasia of the submucous nerve plexus in slowtransit constipation of adults [J]. Eur J Gastroenterol Hepatol, 2000; 12(7)∶755.
  5. 5. Wedel T, Roblick UJ, Ott V, et al. Oligoneuronal hypoganglionosis in patients with idiopathic slowtransit constipation [J]. Dis Colon Rectum, 2002; 45(1)∶54.
  6. 6. ElSalhy M, Norrgard O, Spinnell S. Abnormal colonic endocrine cells in patients with chronic idiopathic slowtransit constipation [J]. Scand J Gastroenterol, 1999; 34(10)∶1007.
  7. 7. ElSalhy M, Norrgard O. Colonic neuroendocrine peptied levels in patients with chronic idiopathic slow transit constipation [J]. Ups J Med Sci, 1998; 103(3)∶223.
  8. 8. MitoloChieppa D, Mansi G, Rinaldi R, et al. Cholinergic stimulation and nonadrenergic, noncholinergic relaxation of human colonic circular muscle in idiopathic chronic constipation [J]. Dig Dis Sci, 1998; 43(12)∶2719.
  9. 9. Tomita R, Fujisaki S, Ikeda T, et al. Role of nitric oxide in the colon of patients with slowtransit constipation [J]. Dis Clolon Rectum, 2002; 45(5)∶ 593.
  10. 10. Pluta H, Bowes KL, Jewell LD. Longterm results of total abdominal colectomy for chronic idiopathic constipation [J]. Dis Colon Rectum, 1996; 39(2)∶160.
  11. 11. Fasth S,Hedlund H, Svaninger G, et al. Functional results after subtotal colectomy and caecorectal anastomosis [J]. Acta Chir Scand, 1983; 149(6)∶623.
  12. 12. Vasilevsky CA, Nemer FD, Balcos EG, et al. Is subtotal colectomy a viable option in the management of chronic constipation? [J]. Dis Colon Rectum, 1988; 31(9)∶679.