Piccirillo M F, Reissman P, Wexner S D
Department of Colorectal Surgery, Cleveland Clinic Florida, Fort Lauderdale 33309, USA.
Br J Surg. 1995 Jul;82(7):898-901. doi: 10.1002/bjs.1800820713.
The aim of this study was to conduct a prospective assessment of the results of total abdominal colectomy and ileorectal anastomosis (TAC) in patients with colonic inertia. Overall, 416 patients were evaluated for chronic constipation. Of the patients 54 (13 per cent) had colonic inertia, defined as diffuse marker delay during transit study without paradoxical puborectalis contraction on cinedefaecography or electromyography. All 54 patients (42 women and 12 men), with a mean age of 49 (range 17-78) years, underwent TAC. Preoperative bowel frequency was a mean of one every 8 days, requiring large doses of laxatives, enemas or both. There was no major postoperative morbidity; five patients were readmitted due to bowel obstruction, three for successful conservative management while the other two required enterolysis. After a mean follow-up of 27 (range 2-51) months these 54 patients reported a mean frequency of spontaneous bowel movements of 3.7 (range 1-10) per day. 'Excellent' or 'good' outcome was reported by 51 patients (94 per cent). TAC can be performed with acceptable morbidity and 94 per cent of patients will have satisfactory improvement in bowel habit.
本研究旨在对结肠无力患者行全腹结肠切除术及回肠直肠吻合术（TAC）的结果进行前瞻性评估。总体而言，416例患者接受了慢性便秘评估。其中54例（13%）患者存在结肠无力，定义为在传输研究中弥漫性标志物延迟，且在排粪造影或肌电图检查中无耻骨直肠肌矛盾性收缩。所有54例患者（42例女性和12例男性），平均年龄49岁（17 - 78岁），均接受了TAC手术。术前排便频率平均为每8天一次，需要大剂量泻药、灌肠或两者并用。术后无严重并发症；5例患者因肠梗阻再次入院，3例经保守治疗成功，另外2例需要行肠粘连松解术。在平均随访27个月（2 - 51个月）后，这54例患者报告自发性排便的平均频率为每天3.7次（1 - 10次）。51例患者（94%）报告结果为“优秀”或“良好”。TAC手术的并发症发生率可接受，94%的患者排便习惯将得到满意改善。
