Advances in the Diagnosis and Treatment of Functional Constipation

doi:10.12114/j.issn.1007-9572.2019.00.062

Abstract

Abstract: Functional constipation（FC） is a disease with a high prevalence commonly encountered in clinical settings，which can seriously impair human physical and mental health.This article reviews the latest progress in the diagnosis and treatment of FC. It mainly includes that the exact etiology and pathogenesis of FC are not yet clear. The diagnosis of FC mainly depends on the symptoms of patients, and constipation caused by intestinal and systemic organic causes should be excluded.Clinical examination methods for FC usually include colorectal transit time measurement，anorectal manometry，balloon expulsion test，defecography and dynamic MRI defecography.The treatments mainly include general management，pharmacotherapy，biofeedback therapy，traditional Chinese medicine treatment，psychological treatment and surgical management.Pharmacotherapy plays a greater role in treating FC than other therapies.Surgical management is only used for those with very serious conditions and without response to medical treatment.Moreover，indicators for surgical intervention should be strictly assessed.Although the surgical intervention can be performed based on individual conditions，the incidence of postoperative complications is high.At the same time, this paper also introduces some new FC therapies which have been gradually applied in clinic in recent years, such as ssacral neuromodulation and fecal bacteria transplantation，and some clinical effects have been achieved. Therefore, this article aims to provide new ideas for the future treatment of FC.

Key words: Constipation, Syndrome differ pathogen fact, Diagnosis, Surgical treatment, Medical treatment

摘要： 功能性便秘（FC）是临床常见病、多发病，严重影响人类身心健康。本文针对FC的最新诊治进展进行了综述，主要包括FC的确切病因及发病机制尚未明确，其诊断主要依赖于患者的症状，同时还需排除肠道及全身器质性疾病所导致的便秘；FC的临床检查方法主要有结肠传输试验、肛门直肠测压、球囊逼出试验、排粪造影、动态磁共振排粪造影等；FC的主要治疗手段有一般治疗、药物治疗、生物反馈治疗、中医治疗、心理治疗、手术治疗等，但目前仍依赖于药物治疗，外科手术仅适用于少数症状非常严重、内科治疗无效的患者，且外科手术治疗需严格把握适应证，根据病因采用个体化手术方式，术后并发症多，远期效果不确切；同时介绍了近年来一些新兴的FC治疗手段逐渐应用于临床，如骶神经调节术、粪菌移植术等，亦取得一定的临床效果。旨在为FC今后的治疗提供新思路。

关键词: 便秘, 病因辨证, 诊断, 手术治疗, 药物治疗

WANG Dongdong,WU Xiangbai. Advances in the Diagnosis and Treatment of Functional Constipation　[J]. Chinese General Practice, 2019, 22(24): 3016-3022. DOI: 10.12114/j.issn.1007-9572.2019.00.062.
王冬冬,吴相柏. 功能性便秘的诊治进展[J]. 中国全科医学, 2019, 22(24): 3016-3022. DOI: 10.12114/j.issn.1007-9572.2019.00.062.

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