Iannelli Antonio, Piche Thierry, Dainese Raffaella, Fabiani Pascal, Tran Albert, Mouiel Jean, Gugenheim Jean
Service de Chirurgie Digestive, Université de Nice-Sophia-Antipolis, Faculté de Médicine, Nice, France.
World J Gastroenterol. 2007 May 14;13(18):2590-5. doi: 10.3748/wjg.v13.i18.2590.
To evaluate the results of sub total colectomy with cecorectal anastomosis (STC-CRA) for isolated colonic inertia (CI).
Fourteen patients (mean age 57.5 +/- 16.5 year) underwent surgery for isolated CI between January 1986 and December 2002. The mean frequency of bowel motions with the aid of laxatives was 1.2 +/- 0.6 per week. All subjects underwent colonoscopy, anorectal manometry, cinedefaecography and colonic transit time (CTT). CI was defined as diffuse markers delay on CTT without evidence of pelvic floor dysfunction. All patients underwent STC-CRA. Long-term follow-up was obtained prospectively by clinical visits between October 2005 and February 2006 at a mean of 10.5 +/- 3.6 years (range 5-16 years) during which we considered the number of stool emissions, the presence of abdominal pain or digitations, the use of pain killers, laxatives and/or fibers. Patients were also asked if they were satisfied with the surgery.
There was no postoperative mortality. Postoperative complications occurred in 21.4% (3/14). At the end of follow-up, bowel frequency was significantly (P < 0.05) increased to a mean of 4.8 +/- 7.5 per day (range 1-30). One patient reported disabling diarrhea. Two patients used laxatives less than three times per month without complaining of what they called constipation. Overall, 78.5% of patients would have chosen surgery again if necessary.
STC-CRA is feasible and safe in patients with CI achieving 79% of success at a mean follow-up of 10.5 years. A prospective controlled evaluation is warranted to verify the advantages of this surgical approach in patients with CI.
评估盲直肠吻合术式的结肠次全切除术（STC-CRA）治疗孤立性结肠无力（CI）的效果。
1986年1月至2002年12月期间，14例患者（平均年龄57.5±16.5岁）因孤立性CI接受手术治疗。借助泻药时，平均排便频率为每周1.2±0.6次。所有受试者均接受了结肠镜检查、肛肠测压、排粪造影和结肠传输时间（CTT）检查。CI定义为CTT上弥漫性标志物延迟，且无盆底功能障碍证据。所有患者均接受了STC-CRA。2005年10月至2006年2月期间，通过临床随访进行前瞻性长期随访，平均随访时间为10.5±3.6年（范围5 - 16年），在此期间，我们记录了排便次数、是否存在腹痛或指诊、止痛药、泻药和/或纤维的使用情况。还询问了患者对手术是否满意。
无术后死亡病例。术后并发症发生率为 21.4%（3/14）。随访结束时，排便频率显著增加（P<0.05），平均每天4.8±7.5次（范围1 - 30次）。1例患者报告有失能性腹泻。2例患者每月使用泻药少于3次，且未抱怨所谓的便秘。总体而言，78.5%的患者表示如有必要会再次选择手术。
对于CI患者，STC-CRA是可行且安全的，在平均10.5年的随访中成功率达79%。有必要进行前瞻性对照评估，以验证这种手术方法对CI患者的优势。
