Gattuso J M, Kamm M A, Morris G, Britton K E
St. Mark's Hospital, London, United Kingdom.
Dis Colon Rectum. 1996 Sep;39(9):1044-50. doi: 10.1007/BF02054697.
In patients with idiopathic megarectum, it is unknown whether abnormality is limited to the dilated large bowel or whether the upper gut is abnormal, as in the various forms of chronic intestinal pseudo-obstruction. This has important implications for treatment, especially surgery.
Ten patients (4 females; median age, 18 (range, 17-26) years) with idiopathic megarectum had contrast studies of the upper and lower gut, radioisotope (technetium-99m liquid and indium-111 solid phase) measurement of gastric, small-bowel, and colonic regional transit, and radiopaque marker colonic studies.
All patients had a dilated large bowel. No patient had radiographic evidence of upper gut dilation. Four patients had normal and six patients had abnormally slow gastric emptying. Both the radioisotope scans and radiopaque marker studies showed abnormal colonic transit. Regions of delay corresponded with the region of dilated bowel. Symptoms of abdominal distention and bloating did not correspond to abnormalities of gastric emptying but rather with effectiveness of rectal evacuation.
Patients with idiopathic megarectum have abnormal colonic transit, delay occurring predominantly in the dilated gut. Marker studies are less sensitive than isotope studies but provide adequate information for clinical purposes. Although motility abnormalities of the upper gut are common, symptoms correlate with large-bowel abnormalities.
在特发性巨直肠患者中，尚不清楚异常是否仅限于扩张的大肠，还是上消化道也存在异常，如同各种形式的慢性肠道假性梗阻那样。这对治疗，尤其是手术治疗具有重要意义。
10例特发性巨直肠患者（4例女性；中位年龄18岁（范围17 - 26岁））接受了上消化道和下消化道造影检查、胃、小肠和结肠区域转运的放射性核素（锝-99m液体和铟-111固相）测量以及不透X线标志物结肠检查。
所有患者均有大肠扩张。无患者有上消化道扩张的影像学证据。4例患者胃排空正常，6例患者胃排空异常缓慢。放射性核素扫描和不透X线标志物检查均显示结肠转运异常。延迟区域与扩张肠段相对应。腹胀和腹部膨隆症状与胃排空异常无关，而是与直肠排空效果有关。
特发性巨直肠患者存在结肠转运异常，延迟主要发生在扩张的肠道。标志物检查不如同位素检查敏感，但可为临床目的提供足够信息。虽然上消化道运动异常常见，但症状与大肠异常相关。
