Tomita Ryouichi, Fujisaki Shigeru, Tanjoh Katsuhisa
First Department of Surgery, Nihon University School of Medicine, Tokyo, Japan.
Am J Surg. 2004 Jan;187(1):76-82. doi: 10.1016/j.amjsurg.2002.12.002.
To investigate how the gastrointestinal transit function changes after ileal J pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) and to study whether gastrointestinal transit time (GTT) has an influence on daily stool frequency, we investigated the relationship between GTT and stool frequency per day.
Forty patients with UC who had undergone restorative proctocolectomy, with ileostomy closure at least 48 to 120 months (mean 96.3) previously, and who had no preoperative and postoperative complications were recruited. They were divided into two groups on the basis of their stool frequency: 26 patients had a stool frequency of less than 6 times per day (group A: 16 men, 10 women; aged 15 to 59 years old, average 36.6) and 14 patients had a stool frequency of 7 or more times per day (group B: 10 men, 4 women; 24 to 56 years old, average 40.9). The GTTs using a radiopaque marker were studied. Interviews concerning the defecation states were performed at the examination.
High nocturnal stool frequency was significantly noted more in group B than in group A (P <0.001). All cases in group A and 12 cases in group B could discriminate flatus from feces, and there were significant differences between groups A and B (P <0.05). Feeling of stool remaining was significantly noted more in group B than in group A (P <0.01). Stool consistency in group A was harder than that in group B (P <0.001). Patients with soiling were significantly noted more in group B compared with those in group A (P <0.001). Incontinence was detected in only 2 cases in group B. Group A showed a better defecation state than group B. In the GTT study, the GTT was almost the same in groups A and B. The small bowel transit, pouch transit, and whole gut transit times in group B were faster than those of group A (P <0.001). Removal length of the terminal ileum in patients after IPAA: patients in group B (13.8 +/- 3.9 cm) had significantly more ileum removed compared with patients in group A (6.3 +/- 2.4 cm; P <0.001). Regression lines in the relationship between removal length of the terminal ileum and individual stool frequency showed there was a correlation between removal length of the terminal ileum and individual stool frequency per day in direct proportion (r = 0.79, P <0.001). A resection of more ileum, up to 15 cm, plays a role in increased stool frequency.
The present results suggested that rapid transit of both the small bowel and pouch may lead to a high stool frequency of 7 or more times per day with a poor defecation state after IPAA. It was also pointed out in this study that an important point is a resection of more ileum, up to 15 cm, plays a role in increased stool frequency.
为了研究溃疡性结肠炎（UC）患者行回肠J袋肛管吻合术（IPAA）后胃肠传输功能如何变化，以及探讨胃肠传输时间（GTT）是否对每日排便次数有影响，我们研究了GTT与每日排便次数之间的关系。
招募40例接受了保留直肠结肠切除术的UC患者，这些患者此前至少在48至120个月（平均96.3个月）前已关闭回肠造口，且无术前和术后并发症。根据他们的排便次数将他们分为两组：26例患者每日排便次数少于6次（A组：16例男性，10例女性；年龄15至59岁，平均36.6岁），14例患者每日排便次数为7次或更多次（B组：男性10例，女性4例；年龄24至56岁，平均40.9岁）。使用不透X线标记物研究GTT。在检查时进行关于排便状态的访谈。
B组夜间排便次数明显高于A组（P<0.001）。A组所有病例和B组12例病例能够区分气体和粪便，A组和B组之间存在显著差异（P<0.05）。B组排便不尽感明显多于A组（P<0.01）。A组粪便硬度高于B组（P<0.001）。与A组相比，B组有粪便污染的患者明显更多（P<0.001）。B组仅2例检测到大便失禁。A组排便状态优于B组。在GTT研究中，A组和B组的GTT几乎相同。B组的小肠传输时间、袋传输时间和全胃肠传输时间比A组快（P<0.001）。IPAA术后患者末端回肠切除长度：B组患者（13.8±3.9cm）切除的回肠明显多于A组患者（6.3±2.4cm；P<0.001）。末端回肠切除长度与个体排便次数之间关系的回归线显示，末端回肠切除长度与每日个体排便次数之间存在正相关（r=0.79，P<0.001）。切除更多的回肠，达15cm，会导致排便次数增加。
目前的结果表明，小肠和袋的快速传输可能导致IPAA术后每日排便次数高达7次或更多次且排便状态不佳。本研究还指出，一个重要的点是切除多达15cm的更多回肠会导致排便次数增加。
