Takesue Y, Yokoyama T, Kodama T, Murakami Y, Imamura Y, Matsuura Y
First Department of Surgery, Hiroshima University School of Medicine, Japan.
Surg Today. 1997;27(5):392-7. doi: 10.1007/BF02385700.
This study was designed to determine the influence of ileal pouch capacity and anal sphincteric function on the clinical outcome after ileal pouch-anal anastomosis. A total of 24 patients who had undergone ileal pouch-anal anastomosis (J pouch) for ulcerative colitis were studied. The 24-hour stool frequency was found to be inversely correlated with the sensitivity threshold volume (STV), maximal tolerance volume (MTV), and distensibility, but was independent of the maximal resting pressure and maximal squeeze pressure. Patients experiencing nocturnal fecal incontinence had maximal resting pressures that were significantly lower than those of nocturnally continent patients. Among the patients with fecal incontinence, those with frequent soiling had lower resting pressures, STV, and distensibility than the patients with intermittent spotting. In addition, the STV in patients needing nocturnal evacuation were lower than those of patients who did not evacuate after falling asleep. The conclusions are as follows. Both stool frequency and the need for nocturnal pouch evacuation correlated directly with pouch volume. Anal incontinence was more common in patients with low internal sphincteric function. In addition, frequent and gross nocturnal incontinent patients demonstrate a worse function in both the anal sphincter and reservoir than those with intermittent spotting.
本研究旨在确定回肠贮袋容量和肛门括约肌功能对回肠贮袋肛管吻合术后临床结局的影响。共研究了24例因溃疡性结肠炎接受回肠贮袋肛管吻合术（J形贮袋）的患者。发现24小时排便频率与感觉阈值容量（STV）、最大耐受容量（MTV）和扩张性呈负相关，但与最大静息压力和最大挤压压力无关。夜间大便失禁患者的最大静息压力显著低于夜间无大便失禁的患者。在大便失禁患者中，频繁弄脏内裤的患者比间歇性少量渗漏的患者静息压力、STV和扩张性更低。此外，需要夜间排便的患者的STV低于入睡后无需排便的患者。结论如下。排便频率和夜间贮袋排便需求均与贮袋容量直接相关。肛门失禁在肛门内括约肌功能低下的患者中更常见。此外，频繁且严重的夜间失禁患者的肛门括约肌和贮袋功能比间歇性少量渗漏的患者更差。
