Stelzner F, Hansen H
Chirurgisches Zentrum, Universität Bonn.
Zentralbl Chir. 1999;124(9):804-11.
Three causes of constipation are known: Chagas' disease, congenital megacolon (Hirschsprung's disease) and continent obstipation. Those diseases are rare, they can be treated successfully by drugs, surgery or psychotherapy. More common is the idiopathic chronic constipation, observed manly in females. A frequent cause is the laxative abuse for many years. The possible etiologic factors are discussed. Based on the fact, that constipation never occurs in patients with a colostomy, reasons for the development of chronic idiopathic constipation are presumed in a disturbance in the distal colon and the anorectum. A possible explanation for the malfunction of defecation could be a different calibre between the usually tight pelvic colon and the wide rectum. In contrast to the apolar structure of the large bowel, the rectum shows a polar fibrous configuration. An additional disorder in the feedback mechanism between continence and defecation could impede the bowel passage. Because of these observations and thoughts, we performed a deep resection of the rectum in 18 patients instead of resecting the dilated and elongated colon. All patients operated that way experienced a major improvement of their bowel function. Postoperatively the bowel movements were regular and normal.
恰加斯病、先天性巨结肠（赫希施普龙病）和节制性便秘。这些疾病较为罕见，可通过药物、手术或心理治疗成功治愈。更常见的是特发性慢性便秘，多见于女性。一个常见原因是多年滥用泻药。文中讨论了可能的病因。基于结肠造口术患者从不发生便秘这一事实，推测慢性特发性便秘的发病原因是远端结肠和直肠肛管功能紊乱。排便功能障碍的一个可能解释是，通常狭窄的盆腔结肠与宽阔的直肠之间管径不同。与大肠的无极性结构不同，直肠呈现极性纤维结构。节制与排便之间反馈机制的额外紊乱可能会阻碍肠道通过。基于这些观察和思考，我们对18例患者进行了直肠深部切除术，而非切除扩张延长的结肠。所有接受该手术的患者肠道功能均有显著改善。术后排便规律且正常。
