Shafik A, Mostafa R M, Shafik A A, Ahmed I
Department of Surgery and Experimental Research, Faculty of Medicine, Cairo University, Cairo, Egypt.
Surg Radiol Anat. 2003 Apr;25(1):16-20. doi: 10.1007/s00276-002-0089-3. Epub 2003 Feb 4.
Radiologic, endoscopic and histomorphologic studies have suggested the presence of a sphincter at the cecocolonic junction (CCJ), while some investigators have denied its existence. To investigate the physiologic activity at the CCJ, the right colon was exposed during right hemicolectomy for early colonic cancer in 11 patients (mean age 43.6+/-12.3 years; 8 men). Three manometric catheters were introduced through colotomy to be separately located in the cecum, CCJ and ascending colon. We determined the CCJ pressure response to cecal and colonic distension by means of a balloon filled with saline in increments of 10 ml. The test was repeated after individual anesthetization of cecum, CCJ and ascending colon. The CCJ measured 1.6+/-0.6 cm in length and had a higher pressure ( p<0.05) than the cecum or colon. Large-volume cecal distension effected a significant CCJ pressure reduction which was augmented as the distension increased. Latency decreased upon increase of the distending volume. In contrast, the CCJ responded to large-volume colonic distension by pressure elevation which increased upon increase of the distending volume. Latency diminished with increased distension. Small-volume cecal or colonic distension effected no CCJ pressure response. The anesthetized CCJ did not respond to distension of the cecum or colon. Likewise, the CCJ did not exhibit a pressure response to distension of the anesthetized cecum or colon. The CCJ is a high-pressure zone which reacts to cecal or colonic distension by dilatation or narrowing, respectively. These data presumably denote the existence of a physiologic sphincter at the CCJ. We suggest that the CCJ pressure response to cecal or colonic distension is reflex and mediated through the cecocolonic inhibitory and colocecal excitatory reflexes, respectively. The role of the CCJ and related reflexes in colonic motility disorders needs to be studied.
放射学、内镜学及组织形态学研究提示在盲结肠交界处（CCJ）存在括约肌，而一些研究者否认其存在。为研究CCJ的生理活性，对11例（平均年龄43.6±12.3岁；8例男性）早期结肠癌患者行右半结肠切除术时暴露右半结肠。通过结肠切开术插入三根测压导管，分别置于盲肠、CCJ及升结肠。我们通过向球囊内注入生理盐水，每次增加10 ml，来测定CCJ对盲肠及结肠扩张的压力反应。在分别麻醉盲肠、CCJ及升结肠后重复该试验。CCJ长度为1.6±0.6 cm，其压力高于盲肠或结肠（p<0.05）。大量盲肠扩张导致CCJ压力显著降低，且随着扩张增加而增强。随着扩张体积增加，潜伏期缩短。相反，CCJ对大量结肠扩张的反应是压力升高，且随着扩张体积增加而增强。随着扩张增加，潜伏期缩短。少量盲肠或结肠扩张未引起CCJ压力反应。麻醉后的CCJ对盲肠或结肠扩张无反应。同样，CCJ对麻醉后的盲肠或结肠扩张也未表现出压力反应。CCJ是一个高压区，分别通过扩张或收缩对盲肠或结肠扩张作出反应。这些数据大概表明在CCJ存在生理性括约肌。我们认为CCJ对盲肠或结肠扩张的压力反应是反射性的，分别通过盲结肠抑制反射和结肠盲肠兴奋反射介导。CCJ及相关反射在结肠运动障碍中的作用有待研究。
