Glia Abdulhakim, Akerlund Jan Erik, Lindberg Greger
Department of Surgery, Karolinska Institutet, Huddinge University Hospital, Stockholm, Sweden.
Dis Colon Rectum. 2004 Jan;47(1):96-102. doi: 10.1007/s10350-003-0016-7. Epub 2004 Jan 14.
A significant proportion of patients with slow-transit constipation have abnormal small-bowel motility. It is unclear whether abnormal small-bowel motility indicates worse results after surgery for slow-transit constipation. We studied the results of colectomy with ileorectal anastomosis in patients with normal and abnormal antroduodenal manometry findings.
Seventeen, consecutive patients who had been referred for intractable constipation and who were found to suffer from slow-transit constipation underwent subtotal colectomy. All patients underwent a set of diagnostic investigations, including whole gut transit time, anorectal manometry, antroduodenal manometry, electromyography of the anal sphincter, balloon expulsion test, and defecography. Patients were followed up after five years.
Patients' median age at the time of the operation was 46 (range, 23-70) years, and the median duration of constipation was 31 (range, 11-65) years. One patient died 21 days after the operation. Three patients developed intestinal pseudo-obstruction after the operation, and two of these died during the follow-up period. Fourteen patients were available for follow-up after a median of five (range, 4-7) years. Bowel frequency was significantly increased from a median of 0 (range, 0-2) times per week to a median of 30 (range, 10-102) times per week after surgery (P<0.001). The incidence of abdominal pain decreased from 94 to 43 percent. Seven of 13 patients (54 percent) continued to have bloating. At long-term follow-up, 12 of 14 patients (86 percent) reported that they had an overall improvement after surgery, despite continuing pain and bloating in a significant proportion of them. The outcome of surgery was good or excellent in seven of seven patients with normal findings on antroduodenal manometry, but only five of nine patients with abnormal manometry findings attained a good result after surgery. We found a trend (P=0.09) toward better long-term results after surgery for slow-transit constipation in patients with a normal antroduodenal manometry before the operation.
相当一部分慢传输型便秘患者存在小肠动力异常。目前尚不清楚小肠动力异常是否预示着慢传输型便秘手术后效果更差。我们研究了十二指肠测压结果正常和异常的患者行结肠直肠吻合术的效果。
17例因顽固性便秘前来就诊且被诊断为慢传输型便秘的连续患者接受了次全结肠切除术。所有患者均接受了一系列诊断检查，包括全胃肠通过时间、肛门直肠测压、十二指肠测压、肛门括约肌肌电图、气囊排出试验和排粪造影。对患者进行了5年的随访。
手术时患者的中位年龄为46岁（范围23 - 70岁），便秘的中位病程为31年（范围11 - 65年）。1例患者术后21天死亡。3例患者术后发生肠道假性梗阻，其中2例在随访期间死亡。14例患者在中位时间5年（范围4 - 7年）后可进行随访。术后排便频率从每周中位0次（范围0 - 2次）显著增加至每周中位30次（范围10 - 102次）（P<0.001）。腹痛发生率从94%降至43%。13例患者中有7例（54%）仍有腹胀。在长期随访中，14例患者中有12例（86%）报告称，尽管仍有相当比例的患者持续存在疼痛和腹胀，但他们在手术后总体情况有所改善。十二指肠测压结果正常的7例患者中，7例手术效果良好或极佳，但测压结果异常的9例患者中，术后仅有5例效果良好。我们发现，术前十二指肠测压正常的慢传输型便秘患者手术后长期效果有更好的趋势（P = 0.09）。
