Batignani G, Monaci I, Ficari F, Tonelli F
Department of Clinical Physiopathology, University of Florence, Italy.
Dis Colon Rectum. 1991 Apr;34(4):329-35. doi: 10.1007/BF02050593.
Functional results after anterior rectal resections are commonly considered satisfactory but variable percentages of postoperative incontinence are often reported. Continence was evaluated after 20 low anterior resections (LAR) and 13 high anterior resections (HAR) by means of clinical assessment, anorectal manometry, and evacuation proctography. Whereas all HAR patients had perfect continence, 10 patients (50 percent of the LAR group had occasional episodes of soiling from liquid feces, 5 patients (25 percent had frequent soiling or occasional incontinence for solid feces, and 1 patient (5 percent had frequent solid stool loss requiring surgical treatment. Anal canal resting pressure at 3 and 4 cm from the anal verge was significantly lower in the LAR group (P less than 0.02 and P less than 0.05, respectively) than in the HAR group. However, the maximum voluntary contraction did not differ between the two groups. Rectoanal inhibitory reflex was found to be present in 17 of the 20 patients with LAR and in all patients with HAR. The volume at which the anal sphincter is continuously inhibited was significantly reduced in the LAR group (P less than 0.001). Also, the conscious rectal sensibility volumes were found to be significantly reduced for threshold, constant, and maximum tolerated volume. Threshold volume for internal sphincter relaxation was lower than the threshold volume for rectal sensation in some patients with LAR. This could allow postoperative fecal soiling. Rectal compliance was decreased (P less than 0.001) in the LAR group. Evacuation proctography, performed in six LAR patients affected by major soiling or solid stool loss, revealed an abnormal obtuse anorectal angle and pathologic lowering of the perineum at rest and during defecation. The concomitance of internal and sphincter impairment, reduction in rectal compliance, and previous pelvis floor muscle damage are postulated as cause affecting continence in patients who underwent LAR.
直肠前切除术后的功能结果通常被认为是令人满意的，但术后大小便失禁的发生率却常有不同报道。通过临床评估、肛门直肠测压法和排粪造影术，对20例低位前切除术（LAR）患者和13例高位前切除术（HAR）患者的大小便失禁情况进行了评估。所有HAR患者大小便控制良好，而10例（占LAR组的50%）患者偶尔有稀便污染情况，5例（25%）患者常有污染或偶尔有固体粪便失禁，1例（5%）患者常有固体粪便丢失，需手术治疗。LAR组距肛缘3厘米和4厘米处的肛管静息压明显低于HAR组（分别为P<0.02和P<0.05）。然而，两组间最大自主收缩并无差异。在20例LAR患者中有17例以及所有HAR患者中均发现存在直肠肛门抑制反射。LAR组中肛门括约肌持续受抑制的容量明显减少（P<0.001）。此外，还发现LAR组患者的直肠感觉阈值、恒定容量和最大耐受容量均明显降低。部分LAR患者内括约肌松弛的阈值容量低于直肠感觉阈值容量。这可能导致术后粪便污染。LAR组的直肠顺应性降低（P<0.001）。对6例受严重污染或固体粪便丢失影响的LAR患者进行的排粪造影显示，存在异常的钝角直肠肛管角，且静息和排便时会阴病理性下降。内括约肌和外括约肌功能受损、直肠顺应性降低以及既往盆底肌肉损伤被认为是影响LAR患者大小便控制的原因。
