乙状结肠扩张对直肠乙状结肠交界处的影响。直肠乙状结肠交界处收紧反射的描述及其临床意义。

Effect of sigmoid colon distension on the rectosigmoid junction. Description of the rectosigmoid junction tightening reflex and its clinical implications.

作者信息

Shafik A, El-Sibai O

机构信息

Department of Surgery and Experimental Research, Cairo University, Cairo, Egypt.

出版信息

Eur Surg Res. 2000;32(5):310-4. doi: 10.1159/000008781.

DOI:10.1159/000008781

PMID:11111177

Abstract

PURPOSE

The sigmoid colon (SC) is the site of stool storage. The stools accumulate in the SC until, at a certain volume, the mechanoreceptors in the SC wall are stimulated, evoking the sigmoidorectal junction inhibitory reflex with a resulting SC contraction, rectosigmoid junction (RSJ) relaxation and passage of the stools to the rectum. However, the RSJ status during stool accumulation in the SC has been scarcely addressed in the literature. The current study investigated this point.

METHODS

A balloon-ended tube was introduced into the SC of 21 healthy volunteers [mean age (+/- SD) 36.8 +/- 10.3 years; 15 men and 6 women]. The pressures in the SC and RSJ were measured by means of a perfused tube, at rest and during balloon inflation with carbon dioxide at two rates: slow (3 ml/min) and rapid (150 ml/min). The tests were repeated after individual anesthetization of the SC and RSJ.

RESULTS

During slow SC distension up to 80 ml included, the RSJ pressure progressively increased while the SC exhibited no pressure response (p > 0.05). At a distending volume of 100 ml, the pressure in the SC rose (p < 0. 01) and declined in the RSJ (p < 0.05), and the balloon was dispelled to the rectum. Rapid SC distension up to 40 ml included, effected no SC pressure response (p > 0.05) while the RSJ showed progressive pressure elevation. At 60 ml distension, the SC recorded a pressure rise (p < 0.001) and the RSJ a pressure decrease (p < 0. 05); the balloon was dispelled to the rectum. The pressure in the RSJ did not respond to distension of the anesthetized SC.

CONCLUSION

The study has shown that, during accumulation of stools in the SC, leakage to the rectum seems to be prevented by a reflex action which we call 'rectosigmoid junction tightening reflex'. This reflex probably acts to control both storage and emptying of the SC contents. Reflex dysfunction might lead to defecation disorders. We suggest that the RSJ tightening reflex be included as an investigative tool in the diagnosis of defecation disorders.

摘要

目的

乙状结肠（SC）是粪便储存的部位。粪便在乙状结肠中积聚，直到达到一定体积，刺激乙状结肠壁中的机械感受器，引发乙状结肠直肠连接抑制反射，导致乙状结肠收缩、直肠乙状结肠连接部（RSJ）松弛，粪便进入直肠。然而，关于乙状结肠中粪便积聚期间直肠乙状结肠连接部的状态，文献中几乎没有涉及。本研究对这一点进行了调查。

方法

将一根带气囊的导管插入21名健康志愿者的乙状结肠[平均年龄（±标准差）36.8±10.3岁；15名男性和6名女性]。在静息状态以及以两种速率（慢速3 ml/min和快速150 ml/min）用二氧化碳对气囊充气期间，通过灌注管测量乙状结肠和直肠乙状结肠连接部的压力。在分别对乙状结肠和直肠乙状结肠连接部进行麻醉后重复这些测试。

结果

在缓慢扩张乙状结肠至80 ml（含）期间，直肠乙状结肠连接部压力逐渐升高，而乙状结肠未出现压力反应（p>0.05）。在扩张至100 ml时，乙状结肠压力升高（p<0.01），直肠乙状结肠连接部压力下降（p<0.05），气囊被排入直肠。快速扩张乙状结肠至40 ml（含）期间，乙状结肠未出现压力反应（p>0.05），而直肠乙状结肠连接部压力逐渐升高。在扩张至60 ml时，乙状结肠压力升高（p<0.001），直肠乙状结肠连接部压力下降（p<0.05）；气囊被排入直肠。直肠乙状结肠连接部的压力对麻醉后的乙状结肠扩张无反应。