特发性慢转运型便秘的诊断与外科治疗

Diagnosis and surgical treatment of idiopathic slow transit constipation

目的 探讨便秘的病因，建立诊断及治疗方法。 方法 对正常人及一组自然便次减少、便意缺乏的患者进行对照研究，详细记录患者病史，并对患者进行肠道转运、肛肠动力学、盆底电生理及排粪造影检查。对保守治疗无效的患者行结肠次全或全切除术，标本作病理检查。 结果 与对照组相比，患者组自然便次减少；肠道转运时间延长；直肠感觉功能降低；模拟排便时盆底肌抑制能力下降。部分患者伴盆腔脏器松弛。病理检查结果显示结肠神经丛细胞减少、变性。术后平均随访３２－２ 个月，有效率达９１－８％ 。 结论 本组疾病是由多种原因引起结肠神经丛损伤，从而使结肠转运功能严重受损的器质性病变；典型临床表现与肠道转运功能检查可为诊断提供依据；充分切除病变结肠能有效缓解便秘。

Objective To investigate the pathogenesis, the diagnostic criteria, and the therapeutic methold of idiopathic slow transit constipation. Methods History recording, bowel transit, anorectal dynamic,electromyography of the pelvic floor and defecography were performed before subtotal or total colectomy for severe constipation resistant to conservative treatment. Results The natural stool frequency was decreased and the time of bowel transit was delayed. The rectal sensation and the ability to reflect inhibition of the pelvic floor when attempting to defecate were damaged significantly compared with normal controls. pathological findings showed that the argyrophilic neurons in the myentenic and submucous plexus reduced quantitatively. All the patients were followed up for an avarage of 32 2 months. Satisfactory functional outcome was obtained in 91 8% of the patients receiving the operation. Conclusions The severe damage colon transit function is due to the impairement of the myentenic and submucous plexus of the colon. It causes vary. The diagnosis of the disease is dependent on the typical clinic features and the bowel transit test. The symptoms of constipation could be relieved effectively by removal of the pathologic colon.