结肠慢通过便秘的外科治疗(附11例报告)

SURGICAL TREATMENT FOR COLONIC SLOW TRANSIT CONSTIPATION (A Repent of 11 Cases)

分析了11例结肠慢通过性便秘手术情况。男性1例为巨乙状结肠伴扭转,女性10例中9例为全结肠通过缓慢,1例为乙状结肠缓慢。2例乙状结肠缓慢者作该肠段切除,而9例全结肠通过缓慢者作全或次全结肠切除。此外术前排粪造影及盆腔造影及手术中10例病人均发现有直肠内脱垂,盆底下降、子宫内脱垂及后倒等。故10例伴有盆底变化者分别作了直肠悬吊、盆底抬高和子宫固定及后倒纠正等手术。术后一个月内均恢复正常排便,无坠胀及排出困难。仅一例术后有梗阻症状。切除结肠病理大部分有肌间神经丛变性等变化。根据上述发现认为本病除少数有解剖因素外,大部分有出口性便秘的盆底变化,推测本病多数为出口梗阻基础上应用大量刺激性泻剂,引起结肠肌间神经丛损伤而最终发生结肠通过性便秘,并提出预防措施。

This is a report of a restrospective review of 11 patients with slow transit constipation who received surgical treatment.One male patient with twisted megasigmoid and one female patient with slow transit in the sigmoid received sigmoidectomy,9 female patients with slow transit in the total colon receivtd total or subtotal colectomy. All of these 10 female patients had internal rectal prolapse.descending pelvic floor,uterine internal prolapse and laid down back,and proctopexy, uteropexy and raising of the pelvic floor were perfermea. After operation, all the patients had normal bowel frequency within one month. Only One patient developed small bowel obstruction 3 months ofter operation. There were some abnormalities of the myenteric plexus of the colon in most of the patients. It was believed that such slow transit constipation with an abnormality of the myenteric plxeus was due to laxative abuse for treating outlet obstructed constipation.