对因溃疡性结肠炎行结肠切除术、黏膜直肠切除术及回肠J袋肛管吻合术5年或更长时间后出现便失禁的患者进行肛管敏感性评估。

Assessments of anal canal sensitivity in patients with soiling 5 years or more after colectomy, mucosal proctectomy, and ileal J pouch-anal anastomosis for ulcerative colitis.

作者信息

Tomita Ryouichi, Igarashi Seigo

机构信息

Department of Surgery, Nippon Dental University School of Dentistry at Tokyo, 2-3-16 Fujimi Chyoda-ku, Tokyo, 102-8158, Japan.

出版信息

World J Surg. 2007 Jan;31(1):210-6. doi: 10.1007/s00268-006-0022-8.

DOI:10.1007/s00268-006-0022-8

PMID:17180565

Abstract

INTRODUCTION

To clarify the significance of anal canal sensitivity contribution to soiling in patients after ileal J pouch-anal anastomosis (IPAA) for ulcerative colitis (UC), we studied the sensory function of the anal canal.

METHODS

Forty patients with UC who had undergone IPAA with ileostomy closure at least 60 to 132 months (mean 103.6 months) previously, and who had no preoperative or postoperative complications were recruited. They were divided into two groups: group A [n = 26; patients without soiling (16 males, 10 females; ages 15-49 years, mean 36.6 years)] and group B [n = 14; patients with soiling (10 men, 4 women; ages 24-56 years, mean 40.9 years)] compared with group C [n = 28; control subjects (18 men, 10 women; aged 19-49 years, mean 38.5 years)]. Patients with soiling were also divided into three groups (B1, rare soiling; B2, occasional soiling; B3, frequent soiling). The anal canal sensitivity threshold was measured using an anal canal electrosensitivity test (ACEST). The measurement point of anal canal was divided into three parts: lower part [1 cm below the dentate line (DL), middle part (just on the DL), and upper part (1 cm above the DL]. A small electric current from a constant-current generator was passed between the electrodes until the patient felt a sensation often described as tingling or pulsing. The threshold of sensitivity was assessed in the upper, middle, and lower parts of the anal canal.

RESULTS

In patients of group C, recording at the middle part of the anal canal showed the best results. The anal canal sensitivity threshold of group B was significantly higher than those of groups A and C at the upper and middle parts (P < 0.0001, respectively). There were no significant differences at the lower part among groups. The anal canal sensitivity threshold of subgroup B3 was significantly higher than those of groups B1 or B2 at both the upper part (P = 0.0002, P = 0.0038, respectively) and middle part (P = 0.0001, P = 0.0480, respectively). There were no significant differences at the lower part among groups.

CONCLUSIONS

The ACEST shows significantly lower sensitivity in the proximal and middle anal canal in IPAA patients with soiling.

摘要

引言

为阐明回肠J袋肛管吻合术（IPAA）治疗溃疡性结肠炎（UC）后患者肛管感觉功能对便失禁的影响，我们对肛管的感觉功能进行了研究。

方法

招募40例曾接受IPAA并在至少60至132个月（平均103.6个月）前关闭回肠造口术、术前及术后均无并发症的UC患者。将他们分为两组：A组[n = 26；无便失禁患者（男16例，女10例；年龄15 - 49岁，平均36.6岁）]和B组[n = 14；有便失禁患者（男10例，女4例；年龄24 - 56岁，平均40.9岁）]，并与C组[n = 28；对照受试者（男18例，女10例；年龄19 - 49岁，平均38.5岁）]进行比较。有便失禁的患者又分为三组（B1，轻度便失禁；B2，偶尔便失禁；B3，频繁便失禁）。采用肛管电感觉测试（ACEST）测量肛管感觉阈值。肛管测量点分为三部分：下部[齿状线（DL）下方1 cm]、中部（恰好在DL处）和上部（DL上方1 cm）。来自恒流发生器的小电流在电极之间通过，直到患者感觉到一种通常被描述为刺痛或搏动的感觉。在肛管的上部、中部和下部评估感觉阈值。

结果

在C组患者中，肛管中部的记录结果最佳。B组肛管上部和中部的感觉阈值显著高于A组和C组（分别为P < 0.0001）。三组下部之间无显著差异。B3亚组肛管上部（分别为P = 0.0002，P = 0.0038）和中部（分别为P = 0.0001，P = 0.0480）的感觉阈值显著高于B1组或B2组。三组下部之间无显著差异。