Verne G Nicholas, Hocking M P, Davis R H, Howard R J, Sabetai M M, Mathias J R, Schuffler M D, Sninsky C A
Malcom Randall Veterans Affairs Medical Center, Gastroenterology Section, Department of Medicine, University of Florida, Gainesville, Florida 32608, USA.
J Gastrointest Surg. 2002 Sep-Oct;6(5):738-44. doi: 10.1016/s1091-255x(02)00022-7.
The purpose of this study was to determine the long-term outcome of patients who had previously undergone subtotal colectomy for severe idiopathic constipation at the University of Florida between 1983 and 1987. In addition, we aimed to determine whether preoperative motility abnormalities of the upper gastrointestinal tract are more common among those patients who have significant postoperative complications after subtotal colectomy. We evaluated 13 patients who underwent subtotal colectomy for refractory constipation between 1983 and 1987 at the University of Florida. Preoperatively, all patients exhibited a pattern consistent with colonic inertia as demonstrated by means of radiopaque markers. Each patient was asked to quantitate the pain intensity and frequency of their bowel movements before and after surgery. In seven patients an ileosigmoid anastomosis was performed, whereas in six patients an ileorectal anastomosis was used. Abdominal pain decreased after subtotal colectomy. Patients with abnormal upper gastrointestinal motility preoperatively experienced greater postoperative pain than those with normal motility regardless of the type of anastomosis. In addition, the number of postoperative surgeries was similar in those patients with abnormal upper motility compared to those with normal motility. Overall, the total number of bowel movements per week increased from 0.5 +/- 0.03 preoperatively to 15 +/- 4.5 (P < 0.007) postoperatively. The results of our study suggest that patients with isolated colonic inertia have a better long-term outcome from subtotal colectomy than patients with additional upper gastrointestinal motility abnormalities associated with their colonic inertia.
本研究的目的是确定1983年至1987年期间在佛罗里达大学因严重特发性便秘而接受次全结肠切除术的患者的长期预后。此外，我们旨在确定上消化道术前动力异常在次全结肠切除术后出现显著术后并发症的患者中是否更常见。我们评估了1983年至1987年期间在佛罗里达大学因难治性便秘接受次全结肠切除术的13例患者。术前，所有患者均表现出与结肠惰性一致的模式，这通过不透射线标记物得以证实。每位患者都被要求量化手术前后排便的疼痛强度和频率。7例患者进行了回肠乙状结肠吻合术，而6例患者采用了回肠直肠吻合术。次全结肠切除术后腹痛减轻。无论吻合术类型如何，术前上消化道动力异常的患者术后疼痛比动力正常的患者更严重。此外，上消化道动力异常的患者与动力正常的患者术后手术次数相似。总体而言，每周排便总数从术前的0.5±0.03增加到术后的15±4.5（P<0.007）。我们的研究结果表明，与伴有上消化道动力异常的结肠惰性患者相比，单纯结肠惰性患者接受次全结肠切除术后的长期预后更好。
