Ho Y H, Goh H S
Department of Colorectal Surgery, Singapore General Hospital, Singapore.
Singapore Med J. 1996 Jun;37(3):291-4.
This study was conducted to ascertain the incidence of patients requiring surgery for intractible constipation. We also aimed to determine the anorectal physiology findings which influenced the surgery, and the outcome of surgical intervention.
A prospective study was done on 217 patients (34 men, 183 women; mean age 59 years [SD 17.7]) managed in a tertiary referral centre. Physiological tests consisting of transit marker studies, anal manometry, electromyography (EMG) and synchronised mano-myo-cinedefaecography (SMC), were then performed where appropriate. Surgical management was based on the results of these investigations. The mean follow-up was 19.6 months (SD 9.3).
Eighteen patients (8.3 percent) underwent surgery: 2 for Hirschsprung's disease, 8 for colonic inertia (CI) and 8 for obstructed defaecation (OD). CI patients were younger than the OD patients (p = 0.03). Transit marker studies were abnormal but manometry was not different from the OD patients. The latter were identified on SMC to have rectoceles, sigmoidocele or rectal intussusception. The stool frequency significantly improved after surgery (before = 1.9 bowel motions a week [SD 0.9], after = 8.8 bowel motions a week [SD 1.2]; p = 0.003). There were no complications.
A small but significant proportion of constipation patients require surgery. Good results are obtainable when surgery is directed by the findings of anorectal physiology investigations.
本研究旨在确定因顽固性便秘而需要手术治疗的患者的发病率。我们还旨在确定影响手术的肛门直肠生理学检查结果以及手术干预的结果。
在一家三级转诊中心对217例患者（34例男性，183例女性；平均年龄59岁[标准差17.7]）进行了一项前瞻性研究。然后在适当情况下进行了包括转运标记物研究、肛门测压、肌电图（EMG）和同步测压-肌电图-排粪造影（SMC）在内的生理学检查。手术管理基于这些检查的结果。平均随访时间为19.6个月（标准差9.3）。
18例患者（8.3%）接受了手术：2例为先天性巨结肠，8例为结肠无力（CI），8例为排便梗阻（OD）。CI患者比OD患者年轻（p = 0.03）。转运标记物研究异常，但测压与OD患者无差异。后者在SMC检查中被发现有直肠膨出、乙状结肠膨出或直肠套叠。术后大便频率显著改善（术前=每周1.9次排便[标准差0.9]，术后=每周8.8次排便[标准差1.2]；p = 0.003）。无并发症发生。
一小部分但比例可观的便秘患者需要手术治疗。根据肛门直肠生理学检查结果进行手术可取得良好效果。
