Nyam D C, Pemberton J H, Ilstrup D M, Rath D M
Department of Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
Dis Colon Rectum. 1997 Mar;40(3):273-9. doi: 10.1007/BF02050415.
Developments in anorectal physiologic testing have facilitated better understanding of the process of defecation and factors that might cause chronic constipation.
Patients with severe idiopathic chronic constipation were evaluated using colonic transit and pelvic floor function in an attempt to identify those patients suitable for aggressive surgical intervention.
Among 1,009 patients studied using either a marker or scintigraphic transit technique and tests of pelvic floor function, 52 with slow-transit constipation (STC) were identified and underwent abdominal colectomy and ileorectostomy (IRA). Twenty-two patients had pelvic floor dysfunction and STC; these patients underwent initial pelvic floor retraining followed by IRA. A total of 249 patients had pelvic floor dysfunction without evidence of slow-transit and were offered pelvic floor retraining alone. The remaining 597 patients had no quantifiable abnormality of colon or pelvic floor dysfunction; these patients had normal transit constipation/irritable bowel syndrome and were treated medically. There were, thus, 74 patients operated on, 68 women, with a mean age of 53 years and a mean follow-up of 56 months. There was no operative mortality, seven patients (9 percent) had small-bowel obstruction, and nine patients (12 percent) had prolonged ileus. All patients were able to pass a stool spontaneously, 97 percent of patients were satisfied with the results of surgery, and 90 percent have a good or improved quality of life. There was no difference in the outcome of surgery in patients with STC alone compared with STC and pelvic floor dysfunction.
Physiologic evaluation reliably identified patients with severe chronic constipation who might benefit from surgery. IRA is safe and effective, resulting in prompt and prolonged relief of constipation.
肛肠生理测试的发展有助于更好地理解排便过程以及可能导致慢性便秘的因素。
对重度特发性慢性便秘患者进行结肠传输和盆底功能评估，以确定那些适合积极手术干预的患者。
在1009例采用标志物或闪烁扫描传输技术及盆底功能测试的患者中，识别出52例慢传输型便秘（STC）患者，并接受了腹段结肠切除术和回肠直肠吻合术（IRA）。22例患者存在盆底功能障碍和STC；这些患者先接受了盆底功能再训练，随后进行了IRA。共有249例患者存在盆底功能障碍但无慢传输证据，仅接受了盆底功能再训练。其余597例患者未发现结肠或盆底功能障碍的可量化异常；这些患者患有正常传输型便秘/肠易激综合征，接受了药物治疗。因此，共有74例患者接受了手术，其中68例为女性，平均年龄53岁，平均随访56个月。无手术死亡病例，7例患者（9%）发生小肠梗阻，9例患者（12%）出现麻痹性肠梗阻延长。所有患者均能自主排便，97%的患者对手术结果满意，90%的患者生活质量良好或有所改善。单纯STC患者与合并STC和盆底功能障碍患者的手术结果无差异。
生理评估能可靠地识别可能从手术中获益的重度慢性便秘患者。IRA安全有效，可迅速并长期缓解便秘。
