慢传输型便秘术后的便秘复发和大便失禁

Recurrent constipation and incontinence after surgery for slow-transit constipation

目的探讨不同肛门压力下的不同种类型慢传输型便秘(STC)行不同术式后便秘复发和大便失禁问题。方法对中国医科大学附属盛京医院1996-2006年106例STC分别行回肠直肠吻合、回肠乙状结肠吻合及保留回盲瓣的盲肠直肠吻合。按照是否有直肠排空疾病分为单纯性STC和合并直肠排空障碍的STC,对所有病人进行直肠肛管向量测压,根据测压的结果分为低压力、高压力和正常压力,记录便秘复发和便失禁情况。结果单纯性STC术后便秘复发及便失禁的发生率均低于合并直肠排空障碍者(P<0.05),对于合并直肠排空障碍的STC,随着压力的增高术后便秘复发率逐渐增加(P<0.05),而便失禁则逐渐减少(P<0.05)。3种术式中,保留回盲瓣的盲肠直肠吻合术后便失禁发生率较低(P<0.05)但有较高的便秘复发风险(P<0.05)。结论对于STC,保留回盲瓣的盲肠直肠吻合可以很好的预防失禁但同时又增加便秘复发的风险,而其中合并直肠排空障碍者较单纯性STC既容易发生术后便秘复发,又容易发生便失禁,术前肛门低压力者术后发生便失禁的风险较大,而高压力则容易引起便秘复发。

Objective To evaluated the recurrent constipation and incontinence for different anal pressure with different operating technique for slow -transit constipation（STC）. Methods 106 patients with STC received surgery as ileorectal anastomosis（IRA）, ileosigmoidal anastomosis ISA ） or cecorectal anastomosis （CSA） from 1996 to 2006 in Shengjing Hospital of China Medical University. The patients were divided into STC-ONLY group and STC - rectal evacuatory disorder （STC-RED） group according to whether involve the rectum, and subsequently the latter were divided into low pressure group,high pressure group and normal pressure group on the basis of vectorial manometry. Results The recurrent constipation and incontinence of STC-ONLY group was lower than that of STC-RED group （ P 〈 0.05 ）, for the latter, with the gradually raising anal pressure the rate of recurrent constipation increased （ P 〈 0.05）, however the rate of incontinence decreased （ P 〈 0. 05 ）. About the three different techniques, incontinence happened least after the CSA （ P 〈 0.05 ）, but there were more risk of constipation recurrence （ P 〈 0. 05）. Conclusion For the surgery of STC, the technique of CSA has the merit for preventing the incontinence after operation, but the risk of constipation recurrence is high on the other hand. Compared with the STC-ONLY, the STC-RED had high risk for recurrent constipation and incontinence, this result was concerned with anal pressure.