Bernstein C N, Rollandelli R, Niazi N, Robert M, Hirsh T, Munakata J, Mayer E A
Department of Medicine, University of Manitoba, Winnipeg, Canada.
Am J Gastroenterol. 1997 Jan;92(1):103-8.
The afferent innervation of ileoanal pouches plays an important role in perception and in reflex regulation of pouch function. We aimed to characterize afferent nerve function in ileoanal pouches and thereby explain the clinical presentation of patients with such pouches.
In eight patients who underwent surgery for active ulcerative colitis, perception of balloon distention of the pouch was measured using an electronic visceral distention device. In addition, pouch compliance and ileoanal reflex function were determined. Studies were performed during the initial stage of pouch creation (pouch without connection to proximal ileum, study 1) and a mean of 6.6 wk (range = 2-12 wk) after the second stage of the surgery (proximal ileum in continuity with the pouch, study 2). Nine normal volunteers made up the control group.
When expressed as intrapouch pressure, thresholds for stool and discomfort sensations were similar in patients with a pouch and controls. However, during ramp distention, patients with a pouch had a lower volume threshold for stool sensation (143 +/- 45 ml vs 300 +/- 30 ml, p = 0.009). The initial sensation of discomfort was experienced in the perineum at the S3 dermatome in all eight patients. At higher distention pressures, all patients with a pouch referred sensations to the abdomen, as opposed to only one of nine controls with such a referral pattern (p < 0.0001). Pouch compliance was markedly reduced during study 1 but normalized after continuity was established with the proximal ileum. Anal sphincter function in patients with a pouch was similar to that in controls.
Afferent pathways from both the ileum and rectum play a role in the mediation of sensations during mechanical distention of the ileoanal pouch and can explain a number of clinical features of patients with a pouch. The thresholds for activation of these pathways are not significantly altered by long-standing colorectal inflammation or by creation of the ileoanal pouch. Continuity with the proximal ileum significantly influences pouch compliance.
回肠肛管储袋的传入神经支配在储袋功能的感知和反射调节中起重要作用。我们旨在描述回肠肛管储袋传入神经功能的特征，从而解释此类储袋患者的临床表现。
对8例因活动性溃疡性结肠炎接受手术的患者，使用电子内脏扩张装置测量储袋对球囊扩张的感知。此外，还测定了储袋顺应性和回肠肛管反射功能。研究在储袋创建初期（储袋未与近端回肠连接，研究1）以及手术第二阶段后平均6.6周（范围=2 - 12周）（近端回肠与储袋相连，研究2）进行。9名正常志愿者组成对照组。
以储袋内压力表示时，有储袋的患者和对照组的排便和不适感阈值相似。然而，在斜坡扩张过程中，有储袋的患者排便感觉的容量阈值较低（143±45 ml对300±30 ml，p = 0.009）。所有8例患者在S3皮节的会阴部均有最初的不适感。在较高扩张压力下，所有有储袋的患者都将感觉牵涉至腹部，而对照组9名患者中只有1名有这种牵涉模式（p < 0.0001）。在研究1期间储袋顺应性明显降低，但在与近端回肠建立连续性后恢复正常。有储袋患者的肛门括约肌功能与对照组相似。
来自回肠和直肠的传入通路在回肠肛管储袋机械扩张时的感觉介导中起作用，并且可以解释有储袋患者的一些临床特征。长期的结肠直肠炎症或回肠肛管储袋的创建并未显著改变这些通路的激活阈值。与近端回肠的连续性显著影响储袋顺应性。
