Degen L P, von Flüe M O, Collet A, Hamel C, Beglinger C, Harder F
Division of Gastroenterology, University Hospital, Basel, Switzerland.
Ann Surg. 1997 Dec;226(6):746-51; discussion 751-2. doi: 10.1097/00000658-199712000-00011.
We have recently described a reservoir for rectal replacement after total mesorectal excision for rectal carcinoma. The ileocecal segment with its intact extrinsic nerve and blood supply is placed between the ascending colon and the anal canal. This reconstruction has been shown to provide good defecation quality and anorectal function. Whether gastric emptying and small as well as large bowel transit are affected by this transposition remains unclear. Our aim was to quantify whole gut transit in such patients and compare it with that of a matched group of controls.
Gastric emptying rates and small intestinal and colonic transit times were assessed scintigraphically in 12 patients aged 46 to 87 years with ileocecal reservoir reconstruction after total mesorectal excision and compared to a sex-matched group of asymptomatic healthy volunteers of similar age. Gastric emptying rates and small intestinal and colonic transit times were calculated as described previously. Data were compared using Wilcoxon's signed rank test for gastric emptying rates and small bowel transit or by analysis of variance for colonic transit; p < 0.05 was considered significant.
Gastric time for half of the meal (T50) was 161 +/- 16 minutes for patients and 201 +/- 22 for the controls. Small bowel transit time was 150 +/- 15 minutes for patients and 177 +/- 22 for the controls. Geometric center at 6 hours was 1.53 +/- 0.13 for patients and 1.27 +/- 0.16 for the controls. Geometric center at 24 hours was 2.96 +/- 0.23 for patients and 2.57 +/- 0.25 for the controls. Data are mean +/- SEM.
Gastric emptying rates and small bowel transit and colonic transit times (expressed as geometric center at 6 and 24 hours) were similar in patients with ileocecal reservoir reconstruction and in a sex- and age-matched group of healthy controls. We conclude that the transposition of an ileocecal segment with intact extrinsic neurovascular supply between the sigmoid colon and the anal canal does not alter whole gut transit, not even in any of the presumably key regions.
我们最近描述了一种用于直肠癌全直肠系膜切除术后直肠替代的储袋。带有完整外在神经和血液供应的回盲部段置于升结肠和肛管之间。这种重建已被证明可提供良好的排便质量和肛门直肠功能。这种转位是否会影响胃排空以及小肠和大肠传输尚不清楚。我们的目的是量化此类患者的全肠道传输，并将其与匹配的对照组进行比较。
对12例年龄在46至87岁之间、接受全直肠系膜切除术后回盲部储袋重建的患者进行放射性核素闪烁扫描评估胃排空率以及小肠和结肠传输时间，并与年龄和性别匹配的无症状健康志愿者组进行比较。胃排空率以及小肠和结肠传输时间的计算方法如前所述。使用Wilcoxon符号秩检验比较胃排空率和小肠传输数据，或使用方差分析比较结肠传输数据；p<0.05被认为具有统计学意义。
患者进餐一半时的胃排空时间（T50）为161±16分钟，对照组为201±22分钟。患者的小肠传输时间为150±15分钟，对照组为177±22分钟。患者在6小时时的几何中心为1.53±0.13，对照组为1.27±0.16。患者在24小时时的几何中心为2.96±0.23,对照组为2.57±0.25。数据为平均值±标准误。
回盲部储袋重建患者与年龄和性别匹配的健康对照组的胃排空率、小肠传输和结肠传输时间（以6小时和24小时时的几何中心表示）相似。我们得出结论，在乙状结肠和肛管之间转位具有完整外在神经血管供应的回盲部段不会改变全肠道传输，甚至在任何可能的关键区域也不会改变。
