慢输送型便秘高选择性肠段切除治疗的研究

Study of High Elective Colectomy for Functional Constipation

目的 :介绍结肠功能性便秘患者经全结肠测压及 X线对标记物定位拍片 ,了解便秘患者结肠受累范围、同时作高度选择性肠段切除治疗便秘 ,观察其疗效。方法 :收集了 4 5例健康成人及 3l例结肠运输功能缓慢性便秘患者 ,采用瑞典生产的全消化道测压仪 ,通过电子肠镜将测压管送入回盲部。分别测得两组人体结肠腔内的最高收缩平均压 ,静息压 ,每 5 m in单位时间内收缩次数以及平均收缩间期持续时间。同时又分别给于作空腹结肠模拟充盈以及饮食后测压 ,了解其在不同状态下的结肠腔压力变化 ,采用“B”超手段了解测压管所在肠道位置 ,精确定位。对于 31例结肠运输缓慢性便秘患者施行高选择性结肠段切除术 ,并作组织学检查。结果 :正常组与患病组最高收缩压分别为 5 8.2 mm Hg、4 0 .8mm Hg,静息压分别为 2 0 .8mm Hg、10 .4mm Hg,平均每 5 min单位时间内收缩 4 .5 3次、3.5次 ,平均收缩间期 2 1.9s、 34.3s。正常组结肠模拟充盈后其压力较空腹压力有明显提高 ,而缓慢运输功能性便秘患者该项变化不显著 ;患者术后排便功能恢复正常 ,组织学检查均提示神经细胞结明显减少、萎缩 ,肌纤维变薄、变细 ,有中断现象。结论 :正常人与便秘人群的肠道内压力有明显差异 ,测压对便秘患者的高选择性结肠段切除手术能起指导作用?

Objective:Cases with functional constipation were measured in pressure and motion of total colon for clearing range of disorder. Those cases were performed with the highly elective colectomy.The effect of treatment was studied. Methods:45 normal adults and 31 cases with functional constipation were measured in pressure in cecum with total alimentary tract manometer made in Sweden. The highest mean systole pressure, quiescent pressure, systole times per five minutes and mean systole interval time of colon were compared between the two groups. The measurement was performed when fasting and colon mimic turgor. The manometer tube was confirmed in the place of colon with B-ultrasound.31 cases of functioned constipation were performed highly elective colectomy and pathologic histology diagnosis.Results:The highest systole pressure were 58.2 mmHg and 40.8 mmHg in the normal group and the patient group .The quiescent pressures in the two groups were 20.8 mmHg and 10.4 mmHg respectively. The systole times per five minutes were 4.53 and 3.5. The mean systole interval time were 21.9s and 34.3s. The pressure of the normal group with colon mimic turgor was higher than that when fasting, but the alteration of pressure of the patient group was not significant. The function of postoperative defecation in the patients became normal. Pathologic examination suggested neurocyte of the colon was atrophy and leiomyfiber became thin and abruptive.Conclusion:The pressure of colon between the normal and the constipational is different. The measurement of pressure is useful for the constipation patients to have high elective colectomy. The surgical treatment is valuable for constipation treatment.