Hata Y, Shinada Y, Sasaki F, Kameda H, Saji Y, Nishikawa M, Uchino J
Nihon Geka Gakkai Zasshi. 1986 May;87(5):531-5.
In this paper, a new operative procedure for patients with chronic constipation with megarectum and its results are presented. Nine cases of idiopathic chronic constipation and one case of short aganglionosis showing megarectum underwent this operation. An incision was placed on the dentate line at 6 o'clock and the internal sphincter muscle was identified. The incision was extended to this muscle. The blunt division between the internal and external sphincter muscles was orally advanced 5 cm from the dentate line. The all layers of anus and lower part of rectum in length of 5 cm were clamped by 2 forceps in width of 1 cm. The mucosal and muscular layers were bilaterally cut in the outer side of the forceps. The rectum on the top of the forceps was pulled through to the dentate line and was anastomosed there; i.e. the posterior part of the anus was replaced by the rectal wall. Bowel habits of operated patients were evaluated at 1 to 3 years after the operation. Complete cure was obtained in 7 cases (including 1 case with aganglionosis). Three cases improved but needed sometimes suppositories. This procedure, sphinctero-myectomy and-plasty may be an operation of choice for chronic constipation with megarectum.
本文介绍了一种针对患有巨直肠的慢性便秘患者的新手术方法及其结果。9例特发性慢性便秘患者和1例表现为巨直肠的短节段无神经节细胞症患者接受了该手术。在齿状线6点处做切口，识别内括约肌。切口延伸至该肌肉。内、外括约肌之间的钝性分离从齿状线向口侧推进5厘米。用两把宽度为1厘米的钳子夹住肛门全层和5厘米长的直肠下段。在钳子外侧将黏膜层和肌层双侧切开。将钳子顶端的直肠拉至齿状线并在该处吻合；即肛门后部被直肠壁替代。在术后1至3年对手术患者的排便习惯进行评估。7例（包括1例无神经节细胞症患者）获得完全治愈。3例有所改善，但有时需要使用栓剂。这种手术，即括约肌肌切除术和成形术，可能是治疗巨直肠慢性便秘的一种选择手术。
