The Study On The Mechanism Of Curative Effect Evaluation By MR Defecography On Modified Jichuan Jian In Treating Constipation Of Spleen And Kidney Yang Deficiency

Objective:To evaluate clinical efficacy of modified Jichuan Jian treating spleen and kidney deficiency functional constipation, and to probe into the mechanism of MRD in the curative effect evaluation of functional constipation.Methods:1. Twenty voluntary patients (18felmales,2males, aged31-76years, mean age51.3years) with functional constipation were brought into the study. each of them underwent MRD and ED. Static T2-weighted fast spin-echo (FSE) images in the sagittal, axial and coronal planes and Fast imaging employing steady-state acquisition (FIESTA) Dynamic images in a mid-sagittal plane during each maneuver were performed. MRD images were compared with ED ones which is considered the reference standard so far.2.Clinical trials brought into24patients of spleen and kidney yang deficiency with functional constipation. The patients took modified Jichuan Jian orally,1agent daily, decocting two times and mixing to300ml being taken two times in the mornig and evening.The course of treatment was20days. Evaluation of clinical curative effect was done1months after the end of treatment, with the main symptoms of clinical score for constipation and Patient Assessment of Constipation Quality of Life Questionnaire (PAC-QOL), after treatment for one month, the patients who were judged cure, markedly effective and effective for clinical curative effect were examined MRD again, to contrast Photographs with ones before treatment for the measured parameters before and after the treatment as contrast controls, to observe the changes of morphology, and to investigate the mechanism of MRD in the curative effect evaluation of functional constipation.Results:1. For the same patient, the absolute values of the anorectal angle in the resting phase of ED and MRD had no significant difference (p>0.05); while there were differences at a maximal contraction and defecation phase (p<0.05); there were not significant differences between the changes of anorectal angles at defecation and at maximal contraction of the sphincter (p>0.05),and the changes showed a linear correlation.The numbers of cases of rectocele, enterocele descending perineum and mucosal prolapse (intussusception) were tested by paired count data χ2test, there were no significant difference (p>0.05); among the total, the frequency of rectocele, enterocele tested by Kappa test of consistency showed moderate consistency, and the number of cases of mucosal prolapse (intussusception) showed good consistency.Rectocele depth had no statistical difference by two methods of MRD and ED.(p>0.05).MRD can show the other pelvic structural abnormalities in the defecation process, such as bladder prolapse,uterine prolapse, hysteromyoma,sacral-cyst.while the ED can not.2.Clinical trials have shown that, in the group of24cases of spleen and kidney yang deficiency constipation, after taking modified Jichuan Jian orally for20days, clinical curative effect was that:1patients were cured (4.2%); excellent effect in6people (25%), effective in10people (41.7%), invalid in7people (29.2%) and the total effective rate was70.8%. The total main symptoms of clinical scores for constipation and the score of each symptom score after treatment were significantly decreased (P<0.05); each dimension of Patient Assessment of Constipation Quality of Life Questionnaire and the total scores after treatment were obviously decreased (P<0.01).3.After treatment for one month, the patients who were judged cure, markedly effective and effective for clinical curative effect were examined magnetic MRD again, the results showed that: before and after treatment, there was no statistically significant difference between the anorectal angles at rest and at maximal contraction of the sphincter (p>0.05), while there was a difference at defecation (p<0.05); there were not significant differences between the changs of anorectal angles at defecation and at maximal contraction of the sphincter before and after treatment (p>0.05).The values reflecting on pelvic floors function of descending perineum, bladder prolapse and uterine prolapse before and after treatment showed no significant difference before and after treatment; rectocele depth had no statistical difference before and after treatment.Before and after the treatment, the number of cases of pelvic floor achalasia, bladder prolapse, uterine prolapse, descending perineum, mucosal prolapse (intussusception), rectocele, enterocele were tested by paired count data χ2test, there were no significant difference; among the total, the the number of cases of pelvic floor achalasia, mucosal prolapse (intussusception), descending perineum, bladder prolapse and enterocele tested by Kappa test of consistency showed moderate consistency, and the number of cases of rectocele and uterus prolapse, showed good consistency.Contusion:1.Modified Jichuan Jian in treating chronic functional constipation of spleen and kidney deficiency has a good curative effect.2. As a efficacy assessment tool of functional constipation, MRD evaluation has limitations.3. In the main, MRD can replace the functions of ED and with its own advantages.