Ohashi S, Okamoto E, Toyosaka A, Suguro M, Kashitani M, Fujimoto A, Niwamoto H
Nihon Geka Gakkai Zasshi. 1985 Sep;86(9):1277-80.
The disturbance of defecation in the patient with Hirschsprung's disease and the pathophysiology of constipation in the constipated patient with simple megarectum were investigated. In Hirschsprung's disease, an existence of aganglionosis and the sphincter achalasia are two main factors which cause clinical symptoms such as chronic constipation and megacolon. As a surgical treatment, we have routinely performed our modified Duhamel's operation. Postoperative followup study indicated that the most cases in our series have gained a satisfactory defecatory function 1 to 3 years after operation. In chronically constipated patient with simple megarectum, on the other hand, it was found manometrically that the most of them had significantly high anal canal pressure and incomplete anal relaxation after rectal stimulation. These findings indicate that those patients have hypertonic and achalasic sphincter. Therefore, the authors propose "high anal pressure syndrome (HAPS)" for such constipated patient with simple megarectum. As to the surgical treatment, 6 patients with simple megarectum had a complete posterior internal sphincterotomy and the postoperative results were excellent or good in our series.
对先天性巨结肠患者的排便障碍以及单纯性巨直肠便秘患者便秘的病理生理学进行了研究。在先天性巨结肠中，无神经节症和括约肌失弛缓是导致慢性便秘和巨结肠等临床症状的两个主要因素。作为一种外科治疗方法，我们常规施行改良杜哈梅尔手术。术后随访研究表明，我们系列中的大多数病例在术后1至3年排便功能令人满意。另一方面，在慢性便秘的单纯性巨直肠患者中，通过测压发现他们大多数肛管压力显著升高，直肠刺激后肛门松弛不完全。这些发现表明这些患者存在高张性和失弛缓性括约肌。因此，作者针对此类单纯性巨直肠便秘患者提出了“高肛管压力综合征（HAPS）”。关于外科治疗，6例单纯性巨直肠患者接受了完全性后内侧括约肌切开术，在我们的系列中术后结果为优或良。
