Ghosh S, Papachrysostomou M, Batool M, Eastwood M A
Gastrointestinal Unit, Western General Hospital, Edinburgh, UK.
Scand J Gastroenterol. 1996 Nov;31(11):1083-91. doi: 10.3109/00365529609036891.
Patients with chronic idiopathic constipation can be difficult to manage either medically or surgically. We report our experience of long-term follow-up of 21 patients who had undergone colectomy with ileorectal anastomosis for difficult chronic idiopathic constipation.
The patients (19 female, 2 male) were aged 26-68 (median = 46) years and had undergone subtotal colectomy 5-12 (median = 8) years before their assessment. They answered a questionnaire about severity of abdominal pain, bloating, urgency, and straining. They also completed the hospital anxiety and depression questionnaire. Fifteen ulcerative colitis patients with panproctocolectomy and 13 colon cancer patients with colonic resection who had a similar follow-up period served as control groups. The following assessments were performed in chronic idiopathic constipation patients with subtotal colectomy: a) oesophageal manometry; b) scintigraphic gastric emptying test; c) review of barium follow-through; d) glucose H2 breath test; e) urodynamic studies; and f) autonomic function tests.
Twenty-four per cent of patients with chronic idiopathic constipation had a family history of difficult constipation requiring hospital investigations and treatment. At the time of assessment abdominal pain, bloating, urgency, and straining at defecation were all significantly more frequent in patients with chronic idiopathic constipation with colectomy than in the control groups with colectomy. Seventy-one per cent of chronic idiopathic constipation patients had at least one episode of intestinal obstruction after subtotal colectomy, which is significantly higher (P < 0.01) than in the control groups (ulcerative colitis, 13%; colonic carcinoma, 8%). In patients with chronic idiopathic constipation, among those studied, 68% had some oesophageal motor dysfunction: 19% delayed gastric emptying; 10%, prolonged small-bowel transit on barium follow-through; 54%, abnormal urodynamic variables; and 14%, abnormal autonomic function tests.
This study shows considerable morbidity in a selected cohort of patients with chronic idiopathic constipation who were sufficiently disabled by their symptoms to undergo subtotal colectomy. They had more abdominal and rectal symptoms and more frequent intestinal obstructive episodes than control groups with colonic resection. Evidence of generalized smooth-muscle dysfunction and familial occurrence of constipation suggests a primary chronic intestinal pseudo-obstruction-like disorder in some of these patients.
慢性特发性便秘患者无论是药物治疗还是手术治疗都可能难以处理。我们报告了21例因难治性慢性特发性便秘接受结肠切除术并回肠直肠吻合术患者的长期随访经验。
患者（19例女性，2例男性）年龄在26 - 68岁（中位数 = 46岁），在评估前5 - 12年（中位数 = 8年）接受了次全结肠切除术。他们回答了一份关于腹痛、腹胀、便急和排便费力严重程度的问卷。他们还完成了医院焦虑和抑郁问卷。15例接受全直肠结肠切除术的溃疡性结肠炎患者和13例接受结肠切除术的结肠癌患者作为对照组，随访期相似。对接受次全结肠切除术的慢性特发性便秘患者进行了以下评估：a）食管测压；b）闪烁扫描胃排空试验；c）钡剂通过检查回顾；d）葡萄糖氢呼气试验；e）尿动力学研究；f）自主神经功能测试。
24%的慢性特发性便秘患者有难治性便秘家族史，需要住院检查和治疗。在评估时，接受结肠切除术的慢性特发性便秘患者的腹痛、腹胀、便急和排便费力比接受结肠切除术的对照组更为频繁。71%的慢性特发性便秘患者在次全结肠切除术后至少发生过一次肠梗阻，这显著高于（P < 0.01）对照组（溃疡性结肠炎患者为13%；结肠癌患者为8%）。在慢性特发性便秘患者中，68%存在一些食管运动功能障碍：19%胃排空延迟；10%钡剂通过时小肠传输时间延长；54%尿动力学变量异常；14%自主神经功能测试异常。
本研究表明，在一组因症状严重而接受次全结肠切除术的慢性特发性便秘患者中，存在相当高的发病率。与接受结肠切除术的对照组相比，他们有更多的腹部和直肠症状，肠梗阻发作更频繁。全身平滑肌功能障碍的证据和便秘的家族性发生表明，这些患者中的一些人存在原发性慢性肠道假性梗阻样疾病。
