McKee R F, Lauder J C, Poon F W, Aitchison M A, Finlay I G
Department of Surgery, Royal Infirmary, Glasgow.
Surg Gynecol Obstet. 1992 Feb;174(2):145-8.
Eighteen patients with full-thickness prolapse of the rectum were randomized to rectopexy alone (group 1) or with sigmoidectomy (group 2). Three months postoperatively, seven patients in group 1 and two in group 2 complained of severe constipation. One patient in group 1 and three patients in group 2 remained incontinent. The results of colonic marker studies showed a significant increase in the number of markers at day 5 for those in group 1 (preoperative, 7.7 +/- 2.6; postoperative, 14.6 +/- 2.2; t test, p less than 00.1) but no significant increase in group 2 (preoperative, 4.6 +/- 2.2; postoperative 6.8 +/- 2.3; t test, p less than 0.01). No significant changes or differences between the groups were seen in the anorectal angle on videoproctogram. The results of anorectal physiologic studies done postoperatively showed no differences between the groups in maximum resting pressure, sphincter length or saline solution infusion test; however, the patients in group 1 had a significantly greater rectal compliance (group 1, 0.24 +/- 0.02 millimeters mercury per milliliter; group 2, 0.1 +/- 0.02 millimeters mercury per milliliter; p less than 00.1). This may occur because the redundant loop of sigmoid colon causes hold-up of intestinal content and kinking at the junction between the sigmoid colon and the rectum.
18例直肠全层脱垂患者被随机分为单纯直肠固定术组（第1组）或直肠固定术联合乙状结肠切除术组（第2组）。术后3个月，第1组有7例患者、第2组有2例患者主诉严重便秘。第1组有1例患者、第2组有3例患者仍存在大便失禁。结肠标志物研究结果显示，第1组患者在术后第5天标志物数量显著增加（术前，7.7±2.6；术后，14.6±2.2；t检验，p＜0.01），而第2组无显著增加（术前，4.6±2.2；术后，6.8±2.3；t检验，p＜0.01）。在排粪造影中，两组间肛管直肠角未见显著变化或差异。术后进行的肛管直肠生理学研究结果显示，两组在最大静息压、括约肌长度或生理盐水灌注试验方面无差异；然而，第1组患者的直肠顺应性显著更高（第1组，0.24±0.02毫米汞柱/毫升；第2组，0.1±0.02毫米汞柱/毫升；p＜0.01）。这可能是因为冗长的乙状结肠袢导致肠内容物潴留以及乙状结肠与直肠交界处扭结。
