Pucciani Filippo
Department of Surgery and Translational Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
Updates Surg. 2018 Dec;70(4):477-484. doi: 10.1007/s13304-017-0508-y. Epub 2017 Dec 30.
The primary endpoint of this work was to understand the pathophysiology of fecal incontinence manifested after rectal and anal surgery. A retrospective cohort study with negative colonoscopy patients was created and 169 postoperative incontinent patients were analyzed (114 women and 55 men: mean age 58.9 ± 6.3): clinical evaluation, endoanal ultrasound and anorectal manometry reports were scanned. The duration of incontinence was very long, with a mean of 21.7 months. The mean number of bowel movements/week was 18.2 ± 7.2. Urge incontinence was present in 82.2% of patients, mixed with passive incontinence in 44 patients. Patients' Fecal Incontinence Severity Index (FISI) score was 27.0 ± 6.6. Operated patients had significantly lower anal resting pressure (P < 0.01) than controls while patients with colo-anal anastomosis and those who underwent Delorme operation had lowest values (P < 0.01). Maximal tolerated volume and rectal compliance were significantly impaired in operated patients with rectum involvement (colo-anal anastomosis, Delorme, restorative procto-colectomy and STARR). External anal sphincter (EAS) defects were present in 33.1% of all patients and internal anal sphincter (IAS) was damaged in 44.3%: a combined lesion of anal sphincters was detected in 39 patients (23.0%). A positive correlation was found between patients' FISI score and thickness of both sphincters (EAS: ρ 73; IAS: ρ = 81). Malfunctioning continence factors may induce fecal incontinence involving each time, in a different way, the volumetric capacity and/or the motility of the rectum, the perception of the fecal bolus and anal sphincter contraction.
本研究的主要终点是了解直肠和肛门手术后出现的大便失禁的病理生理学。我们开展了一项针对结肠镜检查结果为阴性患者的回顾性队列研究，并对169例术后失禁患者进行了分析（114名女性和55名男性：平均年龄58.9±6.3岁）：扫描了临床评估、肛管超声和肛肠测压报告。失禁持续时间很长，平均为21.7个月。每周排便次数平均为18.2±7.2次。82.2%的患者存在急迫性失禁，44例患者同时伴有被动性失禁。患者的大便失禁严重程度指数（FISI）评分为27.0±6.6。手术患者的肛门静息压显著低于对照组（P<0.01），而结肠肛管吻合术患者和接受德洛姆手术的患者的肛门静息压最低（P<0.01）。直肠受累的手术患者（结肠肛管吻合术、德洛姆手术、全直肠系膜切除和STARR手术）的最大耐受容量和直肠顺应性显著受损。33.1%的患者存在肛门外括约肌（EAS）缺陷，44.3%的患者存在肛门内括约肌（IAS）损伤：39例患者（23.0%）检测到肛门括约肌联合损伤。患者的FISI评分与两种括约肌的厚度之间存在正相关（EAS：ρ=0.73；IAS：ρ=0.81）。控便因素功能失调可能每次以不同方式诱发大便失禁，涉及直肠的容量和/或蠕动、粪块感知及肛门括约肌收缩。
