Nahas Sergio C, Habr-Gama Angelita, Nahas Caio S Rizkallah, Araujo Sergio E Alonso, Marques Carlos F Sparapan, Sobrado Carlos W, Bocchini Sylvio F, Kiss Desiderio Roberto
Department of Gastroenterology, Colorectal Surgery Division, University of São Paulo, School of Medicine, Rua Jabebira 136, 05602-020 São Paulo, SP, Brazil.
Dis Colon Rectum. 2006 Sep;49(9):1371-8. doi: 10.1007/s10350-006-0639-6.
Various techniques have been used in the surgical treatment of Chagasic megacolon, including sympathectomy, sphincterotomy, anterior abdominal resection with high or low anastomosis, pull-through procedures, and Duhamel technique. However, results have not been consistently satisfactory, with reportedly high morbidity and mortality rates. The purpose of this study was to assess the technique and results of anterior rectosigmoidectomy with immediate posterior colorectal end-to-side stapled anastomosis for the treatment of Chagasic megacolon.
A prospective, noncontrolled study between 1989 and 2000 analyzed 49 patients with Chagasic megacolon. Preoperative barium enema confirmed Chagasic megacolon in all patients and preoperative anorectal manometry in 33 patients (67 percent). Rectal stump closure was undertaken by surgical stapling in 41 patients (84 percent); mechanical colorectal anastomosis was accomplished with a circular stapler in all patients.
Symptoms of intestinal constipation ranged from 6 months to 40 years, Chagas' serology was positive in 98 percent of patients, 41 percent used bowel enemas for evacuation, and 71 percent had a history of fecaloma. The overall postoperative complication rate was 20 percent. Surgical complications occurred in 18 percent, 2 percent had nonsurgical complications, and there was no mortality. Postoperative barium enema was performed in 82 percent of cases, confirming the absence of disease. Postoperative anorectal manometry demonstrated normal resting pressure and rectal capacity; the inhibitory reflex remained absent and rectal sensitivity was increased. Ninety-three percent of patients were followed for more than 48 months, and all patients reported daily stool elimination without recurrence of constipation.
The current study indicates that our technique is effective for surgical treatment of patients with Chagasic megacolon.
在恰加斯病性巨结肠的外科治疗中已采用了多种技术，包括交感神经切除术、括约肌切开术、高位或低位吻合的前腹切除术、拖出术以及杜哈梅尔技术。然而，结果并非一直令人满意，据报道发病率和死亡率较高。本研究的目的是评估直肠乙状结肠前切除术并立即进行结直肠后壁端侧吻合术治疗恰加斯病性巨结肠的技术及效果。
一项1989年至2000年的前瞻性非对照研究分析了49例恰加斯病性巨结肠患者。术前钡剂灌肠证实所有患者均为恰加斯病性巨结肠，33例患者（67%）进行了术前肛肠测压。41例患者（84%）通过手术吻合器进行直肠残端闭合；所有患者均使用圆形吻合器完成机械性结直肠吻合。
肠道便秘症状持续6个月至40年，98%的患者查加斯血清学呈阳性，41%的患者使用灌肠剂排便，71%的患者有粪瘤病史。总体术后并发症发生率为20%。手术并发症发生率为18%，2%的患者有非手术并发症，无死亡病例。82%的病例进行了术后钡剂灌肠，证实无疾病残留。术后肛肠测压显示静息压力和直肠容量正常；抑制反射仍然缺失，直肠敏感性增加。93%的患者随访超过48个月，所有患者均报告每日排便且便秘未复发。
本研究表明我们的技术对恰加斯病性巨结肠患者的外科治疗有效。
