Rex D K, Lappas J C, Goulet R C, Madura J A
Department of Medicine, Indiana University Medical Center, Indianapolis.
J Clin Gastroenterol. 1992 Oct;15(3):212-7. doi: 10.1097/00004836-199210000-00007.
We evaluated 224 consecutive patients referred for severe constipation prospectively by strict criteria to determine their candidacy for subtotal colectomy. Eighteen patients had insufficient symptoms to warrant evaluation. Two hundred six patients had anorectal manometry and defecography, and 182 had colonic transit measurement. Forty-nine patients had normal or minimally abnormal studies. One-hundred twenty-nine patients had abnormalities such as outlet obstruction, mild colonic inertia, diffuse gut dysfunction, or combinations of factors not favoring subtotal colectomy. Twenty-eight patients had colonic inertia without outlet obstruction and with disabling symptoms; 19 of these patients underwent subtotal colectomy. Follow-up > or = 12 months was available in 14 patients from this group. Of these patients, 12 (86%) were clinically improved. Preoperative evaluation accurately predicted postoperative fecal incontinence and likely reduced postoperative constipation. Small-bowel obstruction occurred postoperatively in 4 patients (29%), and remains a major risk of subtotal colectomy even in carefully selected candidates.
我们依据严格标准对224例因严重便秘前来就诊的连续患者进行了前瞻性评估，以确定他们是否适合接受次全结肠切除术。18例患者症状不充分，不值得评估。206例患者接受了肛门直肠测压和排粪造影，182例患者进行了结肠传输测量。49例患者的检查结果正常或仅有轻微异常。129例患者存在诸如出口梗阻、轻度结肠无力、弥漫性肠道功能障碍或不适合次全结肠切除术的多种因素组合等异常情况。28例患者存在无出口梗阻且伴有致残症状的结肠无力；其中19例患者接受了次全结肠切除术。该组中有14例患者获得了≥12个月的随访。在这些患者中，12例（86%）临床症状得到改善。术前评估准确预测了术后大便失禁情况，并且可能减轻了术后便秘。4例患者（29%）术后发生小肠梗阻，即使在精心挑选的患者中，小肠梗阻仍是次全结肠切除术的主要风险。
