Ferrara A, Pemberton J H, Hanson R B
Section of Colon and Rectal Surgery, Mayo Medical School, Mayo Clinic, Rochester, Minnesota 55905.
Am J Surg. 1992 Jan;163(1):83-8; discussion 88-9. doi: 10.1016/0002-9610(92)90257-r.
Nocturnal incontinence may occur after ileoanal anastomosis and may be related to loss of an effective anal canal pressure barrier during sleep; how pressure and contractions in the proximal bowel influence this barrier is unknown. Our aim was to evaluate the relationship between anal canal pressure and contractions and contractile activity of the pouch in continent subjects after ileal pouch-anal anastomosis (IPAA) and of the rectum in normal controls. A fully ambulatory system for 24-hour pressure recording was used. A flexible transducer catheter was introduced endoscopically so that sensors were at 2, 3, 8, 12, 16, and 24 cm from the anal orifice in 12 healthy controls (7 men, 5 women, mean age: 35 years) and 7 fully continent IPAA patients (4 men, 3 women, mean age: 34 years) more than 12 months postoperatively. Twenty-four hour spontaneous motor activity was stored in a 2.5 megabyte (MB) digital portable recorder. Mean anal canal pressure was calculated, and rectal motor complexes and ileal pouch large pressure waves were characterized. During sleep, resting anal canal pressures were similar in the two groups (72 +/- 12 mm Hg in controls versus 66 +/- 9 mm Hg in IPAA patients [mean +/- standard deviation (SD)], p = NS), but anal canal pressure showed cyclic relaxations (periodicity: 95 +/- 11 min in controls, 54 +/- 18 min in IPAA patients, p less than 0.05), during which the mean pressure trough was 15 +/- 4 mm Hg in controls and 14 +/- 5 mm Hg in IPAA patients (p = NS). In the control patients, during sleep, a mean of six rectal motor complexes were identified (range: 3 to 9). In patients with IPAA, during sleep, a mean of eight large pressure waves per hour were identified (range: 2 to 20). Importantly, in both controls and patients, rectal motor complexes or large pressure waves were always accompanied by rapid return of anal canal pressure from trough to basal values and increased contractile activity. We concluded that, in healthy patients and in continent patients after IPAA, motor activity of the rectum and of the ileal pouch was associated with changes in pressure and contractile activity of the anal canal so that rectal- and neorectal-anal canal pressure gradient, and, in turn, fecal continence were preserved.
回肠肛管吻合术后可能会出现夜间尿失禁，这可能与睡眠期间有效的肛管压力屏障丧失有关；近端肠管的压力和收缩如何影响这一屏障尚不清楚。我们的目的是评估回肠储袋肛管吻合术（IPAA）后控便患者的肛管压力与收缩以及储袋的收缩活动之间的关系，以及正常对照者直肠的相应关系。使用了一种用于24小时压力记录的全动态监测系统。通过内镜插入一根柔性传感导管，使传感器在12名健康对照者（7名男性，5名女性，平均年龄：35岁）和7名术后超过12个月的完全控便的IPAA患者（4名男性，3名女性，平均年龄：34岁）中距离肛门口2、3、8、12、16和24厘米处。24小时的自发运动活动存储在一个2.5兆字节（MB）的数字便携式记录器中。计算平均肛管压力，并对直肠运动复合体和回肠储袋大压力波进行特征描述。在睡眠期间，两组的静息肛管压力相似（对照组为72±12毫米汞柱，IPAA患者为66±9毫米汞柱[平均值±标准差（SD）]，p=无显著性差异），但肛管压力显示出周期性松弛（周期：对照组为95±11分钟，IPAA患者为54±18分钟，p<0.05），在此期间，对照组的平均压力谷值为15±4毫米汞柱，IPAA患者为14±5毫米汞柱（p=无显著性差异）。在对照患者中，睡眠期间平均识别出6个直肠运动复合体（范围：3至9个）。在IPAA患者中，睡眠期间平均每小时识别出8个大压力波（范围：2至20个）。重要的是，在对照组和患者中，直肠运动复合体或大压力波总是伴随着肛管压力从谷值迅速恢复到基础值以及收缩活动增加。我们得出结论，在健康患者和IPAA后控便患者中，直肠和回肠储袋的运动活动与肛管压力和收缩活动的变化相关，从而维持了直肠与新直肠肛管压力梯度，进而保持了大便失禁。
