Stewart J, Kumar D, Keighley M R
University Department of Surgery, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK.
Br J Surg. 1994 Jul;81(7):1051-3. doi: 10.1002/bjs.1800810742.
Over a 16-year period 34 patients underwent surgery for idiopathic megarectum or megacolon; 18 had megarectum with or without megasigmoid, one megacolon only and 15 megarectum and total megacolon (nine with a previous colectomy). Ten patients underwent low rectal or anal anastomosis without pouch formation (colodistal proctostomy, eight; coloanal anastomosis, two), eight had colonic pouch-anal anastomosis (J pouch) and 14 had an ileal J pouch after restorative proctocolectomy; one underwent subtotal colectomy with ileorectal anastomosis and one loop ileostomy alone. There was one death, from intestinal obstruction 24 months after operation. Twenty-seven of 32 evaluable patients without a stoma became fully continent following resection and sphincter-saving procedures. Three of 18 had a poor result after resection for megarectum because of recurrent constipation. One of 14 patients became incontinent after restorative proctocolectomy for megacolon and megarectum and in a further four persistent abdominal distension and pain was treated by pouch excision.
在16年期间，34例患者因特发性巨直肠或巨结肠接受了手术；18例患有伴有或不伴有乙状结肠冗长的巨直肠，1例仅患有巨结肠，15例患有巨直肠和全结肠冗长（9例曾接受过结肠切除术）。10例患者接受了低位直肠或肛门吻合术且未形成贮袋（结肠远端直肠造口术8例；结肠肛管吻合术2例），8例接受了结肠贮袋肛管吻合术（J形贮袋），14例在保留肛门的直肠结肠切除术后接受了回肠J形贮袋术；1例接受了结肠次全切除术加回肠直肠吻合术，1例仅接受了袢式回肠造口术。有1例患者术后24个月死于肠梗阻。32例未行造口的可评估患者中，27例在切除及保留括约肌手术后完全控便。18例因巨直肠接受切除术后，3例因复发性便秘效果不佳。14例因全结肠冗长和巨直肠接受保留肛门的直肠结肠切除术后，1例出现大便失禁，另有4例因持续性腹胀和疼痛接受了贮袋切除术。
