Ho Y H
Department of Colorectal Surgery, Singapore General Hospital, Outram Road, Singapore 169806.
Dis Colon Rectum. 2001 Aug;44(8):1218-20. doi: 10.1007/BF02234648.
Treatment options are limited for intractable excessive stool frequency and incontinence after low anterior resection for rectal cancer. Fortunately, this is quite rare, but three such patients were reported. The patients did not respond to two years of expectant treatment, including medications and anorectal biofeedback. Anorectal physiologic tests and endoanal ultrasound findings were consistent with internal anal sphincter injuries, which are known to occur with transanal insertion of stapling instruments. After postanal sphincter repair, stool frequency was reduced from 5.7 (standard error of the mean, 1.3) to 1.7 (0.3) stools per day. Fecal incontinence requiring pads in all patients was reduced to full continence in two patients and gas incontinence in one. Continence score improved from 13.7 (2.2) to 1.3 (0.3). Mean follow-up was 3.2 (0.5) years. Postanal sphincter repair could be considered when persistent bowel dysfunction after anterior resection is caused by internal sphincter injury.
对于直肠癌低位前切除术后顽固性大便次数过多和大便失禁，治疗选择有限。幸运的是，这种情况相当罕见，但有三例此类患者被报道。这些患者对包括药物治疗和肛门直肠生物反馈在内的两年观察性治疗均无反应。肛门直肠生理检查和肛管超声检查结果与肛门内括约肌损伤一致，已知这种损伤会在经肛门插入吻合器时发生。在进行肛门后括约肌修复后，大便次数从每天5.7次（平均标准误差为1.3次）减少至1.7次（0.3次）。所有患者中需要使用护垫的大便失禁情况在两名患者中减轻至完全控便，一名患者减轻至气体失禁。控便评分从13.7分（2.2分）提高至1.3分（0.3分）。平均随访时间为3.2年（0.5年）。当低位前切除术后持续性肠道功能障碍由内括约肌损伤引起时，可考虑进行肛门后括约肌修复。
