回肠袋肛管吻合术患者失功性括约肌的状态。

State of the defunctionalized sphincter in patients undergoing ileoanal pouch anastomosis.

作者信息

Staniunas R J, Keck J O, Counihan T, Marcello P, Barrett R C, Oster M, Roberts P L, Schoetz D J, Murray J J, Veidenheimer M C

机构信息

Department of Colon and Rectal Surgery, Lahey Clinic, Burlington, Massachusetts 01805, USA.

出版信息

Dis Colon Rectum. 1995 May;38(5):458-61. doi: 10.1007/BF02148843.

DOI:10.1007/BF02148843

PMID:7736874

Abstract

PURPOSE

Our aim was to determine manometric status and functional outcome of the ileoanal pouch procedure in a subset of patients with defunctionalized anal sphincters as a result of long-term fecal diversion.

METHODS

The anal manometric profiles of 12 patients defunctionalized for one year or more were compared with 26 patients with nondefunctionalized anal sphincters. Functional data were obtained from the Lahey Clinic Ileoanal Pouch Registry.

RESULTS

Preoperative manometric data revealed a mean resting pressure of 91.5 mmHg in the nondefunctionalized group vs. 68.7 mmHg in the defunctionalized group; mean squeezing pressure was 171.7 mmHg (nondefunctionalized group) vs. 102.3 mmHg (defunctionalized group); and squeezing pressure volume was 1,283,000 mmHg3 (nondefunctionalized group) vs. 585,000 mmHg3 (defunctionalized group). Functionally both groups had a mean of 6.1 bowel movements in a 24-hour period and could defer defecation for a mean of 2 hours. Leakage occurred in 22 percent of the defunctionalized group and 17 percent of the nondefunctionalized group (P = 0.35).

CONCLUSION

Despite physiologic perturbations, the long-term, defunctionalized anal sphincter can adequately support a restorative procedure without regard to timing of pouch creation.

摘要

目的

我们的目的是确定因长期粪便转流导致肛门括约肌失功能的部分患者回肠贮袋肛管吻合术的测压状态和功能结果。

方法

将12例肛门失功能1年或更长时间的患者的肛门测压数据与26例肛门括约肌未失功能的患者进行比较。功能数据来自拉希诊所回肠贮袋肛管吻合术登记处。

结果

术前测压数据显示，未失功能组的平均静息压力为91.5 mmHg，失功能组为68.7 mmHg；平均收缩压力分别为171.7 mmHg（未失功能组）和102.3 mmHg（失功能组）；收缩压力容积分别为1,283,000 mmHg³（未失功能组）和585,000 mmHg³（失功能组）。在功能方面，两组在24小时内平均排便6.1次，平均可延迟排便2小时。失功能组22%的患者和未失功能组17%的患者出现渗漏（P = 0.35）。