Smith A N, Varma J S, Binnie N R, Papachrysostomou M
University Department of Surgery, Western General Hospital, Edinburgh, UK.
Br J Surg. 1990 Dec;77(12):1361-5. doi: 10.1002/bjs.1800771214.
Colorectal and anal sphincter motility and electrophysiology were investigated in 14 women with profound constipation following hysterectomy and compared with an asymptomatic group of control subjects. Twelve patients complained of significant urinary symptoms. No differences in the motor function of the anal sphincters were detectable. The latency of the pudendoanal reflex was unchanged after hysterectomy. Proctometrograms demonstrated significantly increased rectal volumes and compliance in the hysterectomy group together with deficits of rectal sensory function. In the basal state a significant proximal-to-distal sigmoid colon motility gradient existed only in the control group. Following stimulation with Prostigmin, this gradient was enhanced in the control group but paradoxically reversed in the hysterectomized patients, thus constituting a functional obstruction. Denervation supersensitivity was demonstrable in two patients tested with carbachol provocation but not in control subjects. These findings suggest dysfunction in the autonomic innervation of the hindgut in some patients who had undergone hysterectomy, resulting in severe constipation.
对14名子宫切除术后严重便秘的女性进行了结肠和肛门括约肌运动及电生理研究，并与无症状对照组进行比较。12名患者主诉有明显的泌尿系统症状。未检测到肛门括约肌运动功能的差异。子宫切除术后阴部神经-肛门反射的潜伏期未改变。直肠测压图显示，子宫切除组的直肠容积和顺应性显著增加，同时存在直肠感觉功能缺陷。在基础状态下，仅对照组存在从近端到远端的乙状结肠显著运动梯度。用新斯的明刺激后，对照组的这种梯度增强，但子宫切除患者却出现了相反的逆转，从而构成功能性梗阻。在用卡巴胆碱激发试验的两名患者中可证明去神经超敏反应，但对照组未出现。这些发现表明，部分子宫切除患者的后肠自主神经支配功能存在障碍，导致严重便秘。
