Goes R, Beart R W
Department of Surgery, University of Southern California, Los Angeles, USA.
Dis Colon Rectum. 1995 Sep;38(9):996-1005. doi: 10.1007/BF02049741.
Increasing experience with ileal pouch-anal anastomosis (IPAA) associated with increasing knowledge about anorectal physiology has lead to a large number of publications. The purpose of this review is to evaluate the current understanding of fecal continence as revealed by the evolution of the ileoanal procedure.
Review of the literature covering the most important physiologic parameters involved in fecal continence was undertaken.
Rectoanal inhibitory reflex is probably absent after IPAA but is preserved when distal anorectal mucosa is spared. Anal resting pressure decreases but is less affected when the internal anal sphincter is less traumatized. Squeeze pressure is not importantly affected, and the importance of reservoir function as a determinant of stool frequency is emphasized. IPAA does not affect the coordination between pouch and anal canal motility in the majority of cases. Normal continence is preserved, even during the night, by preserving a gradient of pressure between the pouch and anal canal.
Physiologic concepts are well established, but controversies about the continence mechanism related to IPAA remain. The IPAA procedure has allowed discrimination of details about the function of multiple structures involved in fecal continence.
随着回肠储袋肛管吻合术（IPAA）经验的增加以及对肛肠生理学认识的提高，相关文献大量涌现。本综述旨在评估回肠肛管手术发展所揭示的目前对大便失禁的理解。
对涵盖大便失禁所涉及的最重要生理参数的文献进行综述。
IPAA术后直肠肛管抑制反射可能消失，但保留远端肛管黏膜时该反射得以保留。肛管静息压降低，但当内括约肌受创伤较小时受影响较小。挤压压力受影响不大，且强调了储袋功能作为排便频率决定因素的重要性。在大多数情况下，IPAA不影响储袋与肛管运动之间的协调性。通过保持储袋与肛管之间的压力梯度，即使在夜间也能保持正常的控便能力。
生理学概念已得到充分确立，但关于与IPAA相关的控便机制仍存在争议。IPAA手术使得能够区分参与大便失禁的多个结构的功能细节。
