Adachi Y, Kakisako K, Sato K, Shiraishi N, Miyahara M, Kitano S
First Department of Surgery, Oita Medical University, Japan.
Hepatogastroenterology. 2000 Jan-Feb;47(31):155-8.
BACKGROUND/AIMS: The aim of this study was to evaluate the subjective bowel function after low anterior resection and sigmoid colectomy and to clarify the clinicopathologic factors influencing postoperative bowel habits.
Eighty-six patients who underwent low anterior resection and sigmoid colectomy replied to the questionnaire which consisted of 8 categories of bowel symptoms. The patients were divided into 2 groups: good bowel function showing less than half of symptoms (< 4) and poor bowel function showing more than half of symptoms (> or = 4).
After low anterior resection, patients were often complicated with incomplete evacuation (75%), bowel movement at night (60%), defecation more than twice a day (46%), and soiling (27%). The mean number of defecation/day and frequency of patients with night stools was significantly higher after low anterior resection than sigmoid colectomy (2.81 vs. 2.18, P < 0.05; and 60% vs. 29%, P < 0.05). Poor bowel function after low anterior resection was frequent in patients with high ligation of the inferior mesenteric artery (82%, P < 0.05), injury to the pelvic autonomic nerve (82%, P < 0.05), and blood transfusion; while poor bowel function after sigmoid colectomy was frequent in patients with resected colon measuring 25 cm or more (81%, P < 0.05).
These results indicate that poor bowel function after low anterior resection is associated with high ligation of the inferior mesenteric artery and injury to the pelvic autonomic nerve; while poor bowel function after sigmoid colectomy correlates with length of the resected colon. Less aggressive surgery is needed to preserve good bowel function.
背景/目的：本研究旨在评估低位前切除术和乙状结肠切除术后的主观肠道功能，并阐明影响术后排便习惯的临床病理因素。
86例行低位前切除术和乙状结肠切除术的患者对包含8类肠道症状的问卷进行了回答。患者被分为两组：肠道功能良好组（症状少于一半，即<4个）和肠道功能较差组（症状多于一半，即≥4个）。
低位前切除术后，患者常出现排便不尽（75%）、夜间排便（60%）、每日排便超过两次（46%）和便污（27%）。低位前切除术后患者的每日平均排便次数和夜间排便频率显著高于乙状结肠切除术（2.81对2.18，P<0.05；60%对29%，P<0.05）。低位前切除术后肠道功能较差在肠系膜下动脉高位结扎患者中较为常见（82%，P<0.05）、盆腔自主神经损伤患者中（82%，P<0.05）以及输血患者中；而乙状结肠切除术后肠道功能较差在切除结肠长度达25 cm或更长的患者中较为常见（81%，P<0.05）。
这些结果表明，低位前切除术后肠道功能较差与肠系膜下动脉高位结扎和盆腔自主神经损伤有关；而乙状结肠切除术后肠道功能较差与切除结肠的长度有关。需要采取创伤较小的手术来保留良好的肠道功能。
