Sir Alan Parks Physiology Unit, St Mark's Hospital, Harrow, UK.
Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
Colorectal Dis. 2016 Aug;18(8):O292-300. doi: 10.1111/codi.13431.
Restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis (IPAA) is the most frequently performed operation for intractable ulcerative colitis (UC) and for many patients with familial adenomatous polyposis (FAP). It can be complicated by a functional evacuation difficulty, which is not well understood. We aimed to evaluate the role of defaecating pouchography in an attempt to assess the mechanism of evacuation difficulty in pouch patients.
All RPC patients who had had a defaecating pouchogram for evacuation difficulty at one hospital between 2006 and 2014 were retrospectively reviewed. The findings and features were correlated with the symptoms. Demographic, clinical and radiological variables were analysed.
Eighty-seven [55 (63%) female] patients aged 47.6 ± 12.5 years (mean standard ± SD) were identified. Thirty-five had a mechanical outlet obstruction and 52 had no identified mechanical cause to explain the evacuation difficulty. The mean age of these 52 [33 (63%) female] patients was 48.2 ± 13 years. Of these 52 patients, significantly more used anti-diarrhoeal medication (P = 0.029), complained of a high frequency of defaecation (P = 0.005), experienced a longer time to the initiation of defaecation (P = 0.049) and underwent pouchoscopy (P = 0.003). Biofeedback appeared to improve the symptoms in 7 of 16 patients with a nonmechanical defaecatory difficulty. The most common findings on defaecating pouchography included residual barium of more than 33% after an attempted evacuation (46%, n = 24), slow evacuation (35%, n = 18) and mucosal irregularity (33%, n = 17). Correlation between radiological features and symptoms showed a statistically significant relationship between straining, anal pain, incontinence and urgency with patterns of anismus or pelvic floor descent or weakness seen on the defaecating pouchogram. Symptoms of incomplete evacuation, difficulty in the initiation of defaecation, high defaecatory frequency and abdominal pain were not correlated with the radiological features of the pouchogram.
Defaecating pouchography may be useful for identifying anismus and pelvic floor disorders in pouch patients who have symptoms of straining, anal pain or incontinence. In patients with a high frequency of defaecation and abdominal pain it does not provide clinically meaningful information. Patients who complain of straining, incontinence, anal pain or urgency and have anismus or pelvic floor disorders may benefit from behavioural therapy.
回肠贮袋肛管吻合术（IPAA）是治疗溃疡性结肠炎（UC）和家族性腺瘤性息肉病（FAP）的最常用手术。它可能会出现功能排空困难的并发症，但这种并发症的发病机制尚不清楚。我们旨在评估排粪造影在评估储袋患者排空困难机制中的作用。
回顾性分析了 2006 年至 2014 年间，一家医院因排空困难而行排粪造影的所有 RPC 患者。将检查结果和特征与症状相关联。分析人口统计学、临床和影像学变量。
共 87 例（55 例[63%]女性）患者，年龄 47.6±12.5 岁（均值±标准差）。35 例有机械性出口梗阻，52 例无明确机械性原因解释排空困难。这 52 例（33 例[63%]女性）患者的平均年龄为 48.2±13 岁。在这 52 例患者中，明显更多的人使用了止泻药（P=0.029），抱怨排便频率高（P=0.005），排便开始时间更长（P=0.049），并且进行了储袋镜检（P=0.003）。生物反馈治疗似乎改善了 16 例非机械性排便困难患者中的 7 例症状。排粪造影最常见的发现包括排空后钡剂残留超过 33%（46%，n=24）、排空缓慢（35%，n=18）和黏膜不规则（33%，n=17）。影像学特征与症状之间的相关性表明，在排粪造影中，肛门疼痛、失禁和急迫性与肛门内括约肌失弛缓症、盆底下降或无力的模式之间存在统计学显著关系。不完全排空、排便开始困难、排便频率高和腹痛等症状与储袋造影的影像学特征无相关性。
排粪造影术可能有助于识别有排便困难、肛门疼痛或失禁症状的储袋患者的肛门内括约肌失弛缓症和盆底障碍。在排便频率高和腹痛的患者中，它不能提供有临床意义的信息。有肛门疼痛、失禁、急迫性、排便困难等症状且有肛门内括约肌失弛缓症或盆底障碍的患者可能受益于行为治疗。
