Nordgren S, Cohen Z, Greig P D, Diamant N E
Surg Gynecol Obstet. 1982 Nov;155(5):646-52.
The continent Koch ileostomy constitutes a major improvement in the quality of life for patients requiring an ileostomy. Complete continence is achieved in most patients, although the mechanisms underlying this control of fecal flow are poorly understood. Pressure studies on the pouch, the nipple valve and the outlet were preformed and results showed the presence of a high pressure zone in the nipple valve relative to the pouch. The high pressure zone maintained, even when the intra-abdominal pressure was raised or during contractions of the pouch, and most likely, contributes to continence. The pressure in the nipple valve and outlet was further intermittently increased by spontaneously occurring phasic and tonic contractions. Distention of the pouch with air caused a tonic contraction that was first recorded from the pouch and that traveled aborally along the intestinal layers of the intususcepted nipple valve and the outlet. By frequent emptying of the pouch, such contractions are avoided, and the risk of desusception of the nipple valve may be reduced.
可控性回肠造口术极大地改善了需要进行回肠造口术患者的生活质量。大多数患者能够实现完全控便，尽管对这种粪便排出控制的潜在机制了解甚少。对贮袋、乳头瓣和出口进行了压力研究，结果显示乳头瓣相对于贮袋存在高压区。即使腹内压升高或贮袋收缩时，高压区依然存在，很可能这有助于实现控便。乳头瓣和出口处的压力会因自发出现的阶段性和强直性收缩而进一步间歇性升高。向贮袋内充气使其扩张会引起强直性收缩，该收缩首先从贮袋记录到，并沿套叠乳头瓣和出口的肠壁向口侧传播。通过频繁排空贮袋，可以避免此类收缩，并且可能降低乳头瓣脱套叠的风险。
