Beart R W, Dozois R R, Wolff B G, Pemberton J H
Am J Surg. 1985 Jan;149(1):31-4. doi: 10.1016/s0002-9610(85)80005-2.
To clarify mechanisms of rectal continence, we evaluated 34 patients who had straight or J-pouch ileoanal anastomosis. This evaluation included pressures, anal inhibitory reflex, neorectal capacity, neorectal compliance, and the ability to discriminate stool from gas. Both groups of patients had satisfactory anal sphincter resting pressures and neorectal capacities, and all could discriminate stool from gas despite the absence of any rectal mucosa. We conclude that normal rectal mucosa is not necessary to be able to discriminate stool from gas; a long rectal muscular cuff is not necessary for rectal sensation; essentially normal sphincter function is preserved, and this procedure does not normally fail because of inadequate sphincter function or the absence of the anal inhibitory reflex; and in the presence of normal sphincter function, continence is not dependent on the presence of normal mucosa or the anal inhibitory reflex but correlates with reservoir capacity and compliance as well as with the frequency and strength of intrinsic bowel contractions.
为阐明直肠节制的机制，我们评估了34例行直型或J形贮袋回肠肛管吻合术的患者。评估内容包括压力、肛门抑制反射、新直肠容量、新直肠顺应性以及区分粪便和气体的能力。两组患者的肛门括约肌静息压力和新直肠容量均令人满意，尽管没有任何直肠黏膜，但他们都能区分粪便和气体。我们得出结论，正常的直肠黏膜并非区分粪便和气体所必需；直肠感觉并不需要长的直肠肌袖；基本正常的括约肌功能得以保留，并且该手术通常不会因括约肌功能不足或肛门抑制反射缺失而失败；在括约肌功能正常的情况下，节制并不依赖于正常黏膜或肛门抑制反射的存在，而是与贮袋容量和顺应性以及肠道内在收缩的频率和强度相关。
