Christiansen J, Rasmussen O O
Dept. of Surgery D, Herlev Hospital, University of of Copenhagen, Denmark.
Scand J Gastroenterol. 1996 Aug;31(8):770-3. doi: 10.3109/00365529609010350.
Colectomy for severe constipation has in up to 25% of patients given unsatisfactory results. Failure to cure constipation is in most patients due to rectal dysfunction. The aim of the present study was to evaluate the effect of colectomy in a group of patients who fulfil all the criteria which, with our present knowledge, should predict a favourable result.
Twelve patients with long-standing severe constipation incurable by dietary regulation and medical treatment with demonstrable slow-transit constipation and normal rectal function entered the study.
Ten patients were relieved of their constipation. Two patients continued to be constipated after subtotal colectomy. One had a very highly compliant rectum (preoperatively) with a maximal tolerable volume of 700 ml but normal emptying at defecography and normal emptying of viscous fluid. The patient was subsequently treated with proctectomy and ileo-pouch-anal anastomosis with satisfactory result. One patient with opioid abuse due to abdominal pain was improved by the operation but was still constipated. The opioid abuse continued, however, after the operation owing to continuing abdominal pain. A further three patients complained of abdominal pain, and two developed diarrhoea, one of whom became incontinent.
Subtotal or segmental colectomy should be considered in a small number of patients with severe constipation provided strict criteria are fulfilled. Excessively high rectal volume tolerability may in spite of normal emptying capacity indicate the risk of development of rectal inertia postoperatively and may be a contraindication for surgery.
对于严重便秘患者，结肠切除术在高达25%的患者中效果不理想。大多数患者便秘未能治愈是由于直肠功能障碍。本研究的目的是评估结肠切除术对一组符合所有标准的患者的效果，根据我们目前的认知，这些标准应能预测良好的结果。
12例长期严重便秘患者，经饮食调节和药物治疗无法治愈，经证实存在慢传输型便秘且直肠功能正常，进入本研究。
10例患者便秘症状缓解。2例患者在次全结肠切除术后仍便秘。1例患者（术前）直肠顺应性极高，最大耐受容量为700 ml，但排粪造影时排空正常，粘性液体排空也正常。该患者随后接受了直肠切除术和回肠储袋肛管吻合术，结果满意。1例因腹痛滥用阿片类药物的患者术后症状有所改善，但仍便秘。然而，由于持续腹痛，术后仍继续滥用阿片类药物。另外3例患者主诉腹痛，2例出现腹泻，其中1例出现大便失禁。
对于少数严重便秘患者，若满足严格标准，可考虑行次全或节段性结肠切除术。尽管排空能力正常，但直肠容量耐受性过高可能提示术后发生直肠惰性的风险，可能是手术的禁忌证。
