出口梗阻型便秘中西医研究进展

Research Progress of Traditional Chinese and Western Medicine on Outlet Obstructive Constipation

摘要: 出口梗阻型便秘(outlet obstructive constipation, OOC)是功能性便秘最常见的亚型，临床以排便费力、排便不尽感、肛门阻塞感、排便时间延长、需辅助排便等为主要表现，病程长、易复发、难以根治，严重影响患者情绪及生活质量。据统计，全世界成年人便秘发病率约16%，其中60岁以上老年人发病率约18.1%，OOC约占60%。女性发病率明显高于男性，且随年龄增长发病率升高。现代医学认为本病主要由盆底肌群功能紊乱、直肠解剖结构异常、神经调控失调及心理因素共同导致，治疗以饮食干预、药物、生物反馈、盆底电刺激及手术为主，但存在复发率高、远期疗效有限、部分有创治疗存在并发症风险等问题。中医学将OOC归属于“便秘”“后不利”“魄门失司”等范畴，病位在大肠与魄门，与脾、肝、肾、肺脏腑功能失调密切相关，病机多属本虚标实。中医以辨证论治为核心，采用中药内服、针灸、温针灸、穴位埋线、推拿康复等多种疗法，具有整体调节、副作用小、远期疗效稳定的优势。本文系统梳理近年国内外相关文献，从西医发病机制、诊断技术、治疗手段及中医病因病机、辨证论治、中医药与针灸外治、中西医结合治疗等方面展开综述，分析当前研究不足，展望未来研究方向，旨在为OOC的规范化中西医诊疗提供理论参考。

Abstract: Outlet obstructive constipation (OOC) is the most common subtype of functional constipation. Its main clinical manifestations include straining during defecation, a sense of incomplete defecation, anal obstruction sensation, prolonged defecation time, and the need for assisted defecation. Characterized by a long course, high recurrence rate and difficulty in radical cure, OOC seriously affects patients’ mood and quality of life. Statistical data show that the global incidence of constipation in adults is approximately 16%, with an incidence rate of 18.1% in the elderly over 60 years old, among which OOC accounts for about 60%. The incidence of OOC is significantly higher in females than in males and increases with age. Modern Western medicine holds that the pathogenesis of OOC is mainly attributed to pelvic floor muscle dysfunction, abnormal anatomical structure of the rectum, neurological regulation disorder and psychological factors. Western medical treatments mainly include dietary intervention, medication, biofeedback therapy, pelvic floor electrical stimulation and surgical treatment. However, these treatments are associated with problems, such as high recurrence rate, limited long-term efficacy, and complication risks of some invasive treatments. In traditional Chinese medicine (TCM), OOC is classified into the categories of “constipation”, “posterior dysentery” and “dysfunction of the anal orifice”. The disease is located in the large intestine and anal orifice, and is closely related to the dysfunction of the spleen, liver, kidney and lung. Its pathogenesis is mostly manifested as root deficiency and excess manifestation. Centering on syndrome differentiation and treatment, TCM adopts various therapies including oral administration of Chinese herbal medicine, acupuncture, warm needling, acupoint catgut embedding, and TCM tuina rehabilitation therapy, which possess the advantages of holistic regulation, minor side effects and stable long-term efficacy. By systematically reviewing relevant domestic and foreign literature in recent years, this paper summarizes the research progress of OOC from the perspectives of Western medical pathogenesis, diagnostic techniques and therapeutic methods, as well as TCM etiology and pathogenesis, syndrome differentiation and treatment, internal and external therapies of Chinese medicine and acupuncture, and integrated traditional Chinese and Western medicine treatment. The existing deficiencies in current researches are analyzed and future research directions are prospected, aiming to provide a theoretical reference for the standardized diagnosis and treatment of OOC with integrated traditional Chinese and Western medicine.