Shafik A
Department of Surgery and Experimental Research, Faculty of Medicine, Cairo University, Egypt.
Int Surg. 1996 Jul-Sep;81(3):292-4.
As urge is felt and defecation starts, it is postulated that the colon continuously feeds the rectum with stools until the colon is empty. The relationship of rectal distension at defecation to colonic activity is not yet fully explored. The current communication studies this relationship in 11 patients (mean age 48.4+/-18.8 years, 6 men and 5 women) with transverse colostomy performed after transverse colectomy for cancer of the transverse colon. The rectum was distended by a condom-ended catheter in increments of 10 ml of H20, and the pressures in the right and left colon were measured by balloon catheters introduced through the colostomy. The test was repeated after anesthetizing the rectum or colon, respectively. Upon rectal distension up to sensation of urge, there was no colonic pressure response. At urge (mean distension volume of 160+/-36.7 ml), the left colonic pressure showed a significant rise (p<0.001), while the right colon revealed no response (p>0.05). Rectal distension during rectal or colonic anesthetization effected no colonic pressure response (p>0.05). The left colonic contraction upon rectal distension, being reproducible and absent with the anesthetized rectum or colon, postulates a reflex relationship which we call "recto-colic reflex". This reflex acts at defecation to feed the rectum successively with fecal material until the colon is emptied. Reflex derangement may play a role in defecation disorders.
当产生便意并开始排便时，据推测结肠会持续向直肠输送粪便，直至结肠排空。排便时直肠扩张与结肠活动之间的关系尚未得到充分研究。本报告研究了11例（平均年龄48.4±18.8岁，6例男性和5例女性）因横结肠癌行横结肠切除术后行横结肠造口术患者的这种关系。用末端带避孕套的导管以10毫升水的增量扩张直肠，通过结肠造口插入球囊导管测量左右结肠的压力。分别在麻醉直肠或结肠后重复该试验。在直肠扩张至产生便意时，结肠没有压力反应。在便意出现时（平均扩张体积为160±36.7毫升），左结肠压力显著升高（p<0.001），而右结肠无反应（p>0.05）。直肠或结肠麻醉期间的直肠扩张未引起结肠压力反应（p>0.05）。直肠扩张时左结肠的收缩可重复，且在直肠或结肠麻醉时消失，推测存在一种反射关系，我们称之为“直肠-结肠反射”。这种反射在排便时起作用，依次向直肠输送粪便物质，直至结肠排空。反射紊乱可能在排便障碍中起作用。
