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Background/Purpose: The choice of ileo-anal reconstruction method in children undergoing proctocolectomy remains controversial. Although in adults ileo-anal pouch reconstruction has gained overall acceptance, many paediatric surgeons still advocate straight ileo-anal pull-through. The aim of this study was to assess the outcome and long-term functional results in children who have undergone proctocolectomy and ileo-anal anastomosis (IAA) with a J-pouch. Methods: Medical records of 40 consecutive children who had proctocolectomy and J-pouch IAA between 1991 and 1999 were reviewed for early and late complications, fecal frequency, day- and night-time continence, and pouchitis. The indication for surgery was ulcerative colitis (UC) in 29 (median age at operation, 13 years; range, 9 to 16), Hirschsprung's disease (HD) in 10 (median age at operation, 1.5 years; range, 1 month to 5 years), and familial adenomatous polyposis (FAP) in 1 (age at operation, 6 years). Six of the HD patients had primary pull-through for total colonic aganglionosis and 4 a redo operation for failed primary reconstruction of long segment aganglionosis. Results: There were no fatalities. Early complications (wound infection, early bowel obstruction, prolonged fever) occurred in 12 of 29 (41%) and late complications (bowel obstruction 9, pouch fistula 2) in 11 of 29 (38%) of the UC patients. Overall, 16 of 29 (53%) of the UC patients had complications. All patients with early complications were on systemic steroids at the time of the operation. Pouchitis occurred in 30% of the patients. None of the pouches had to be removed. At last follow-up all patients were continent during the day, 2 patients used protective pads during the night because of occasional staining. The median bowel frequency per 24 hours was 4 (range, 2 to 7); only 2 patients (7%) had to empty their bowel during the night. One (10%) of the HD patients had wound infection, and 3 had episodes of postoperative enterocolitis. Pouchitis-type symptoms have not occurred in HD patients. The median bowel frequency for 24 hours was 3 (range, 2 to 5). None of the HD patients needs to evacuate during the night. The 4 HD patients who are older than 3 years of age are continent. Conclusions: J-pouch IAA is a feasible method of reconstruction in children requiring proctocolectomy. Major complication are common but occur mainly in immunosuppressed patients suffering from UC. Despite high incidence of complications, long-term functional results in terms of continence and bowel frequency are excellent and ensure good quality of life in the great majority of patients.  相似文献   

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Anorectal manometry in premature infants   总被引:1,自引:0,他引:1  
Twenty-eight unselected premature infants were subjected to anorectal pressure studies, using an infusion manometric technique, with a view to establishing normal parameters in this age group. Satisfactory rectal and sphincter pressure readings were obtained in all but one case. In all of these there was a normal anorectal reflex. Low birth weight and prematurity do no preclude a normal anorectal reflex as measured by this technique.  相似文献   

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Of 188 patients having a total proctocolectomy and ileo-anal anastomosis, 95% had a successful procedure and are satisfied with their quality of life. Mortality was zero, and mean hospital stay was 14 days after colectomy and 10 days after closure of the stoma. Pelvic sepsis and small bowel obstruction remained clinical problems in the postoperative period. No male patients were impotent.  相似文献   

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肛管直肠压力测定诊断盆底失弛缓综合征的应用研究   总被引:3,自引:0,他引:3  
目的:比较肛管直肠压力测定、盆底肌电图、排粪造影诊断盆底失驰缓综合征的价值。研究肛管直肠压力测定对盆底失驰缓综合征的分类诊断及临床意义。方法:113例慢性便秘患者同期进行肛管直肠压力测定,盆底肌电图,排粪造影检查。肛管直肠压力测定根据排便时管压力曲线类型和排便指数(排便压/收缩压)将盆底失驰缓综合征分为轻中重三度。19例重度患者采用中医挂线治疗(治疗1组),20例轻中重度患者采用生物反馈(治疗2组),观察治疗前后肛管直肠压力检测指标的变化。22例健康者作为对照。结果:肛管直肠压力测定和佃底肌电图诊断盆底失驰缓综合征的阳性率无明显差异(P>0.05),和排粪造影比较有明显差异(P<0.01)。治疗1组排便驰缓反射,排便压与治疗后比较有明显差异(P<0.01),肛管功能长度,肛管静息压与治疗后比较明显减低(P<0.01)与健康组比较均有明显差异(P<0.01)。治疗2组排便驰缓反射,排便压与治疗后比较有明显差异(P<0.05),肛管功能长度无明显差异(P>0.05)。与健康组比较均有显著差异(P<0.01);若剔除重度患者上述指标有非常显著差异(P<0.01)。结论:肛管直肠压力测定是一种无创的,灵敏度和特异性均好的检查方法。中度盆底失驰缓综合征患者适合保守治疗,重度患者应手术治疗。  相似文献   

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Pouchitis is the most poorly understood complication of ileoanal anastomosis. The incidence reported in the literature ranges from 7 to 42% as there are no diagnostic criteria. The various clinical symptoms and endoscopic findings raise the possibility that pouchitis is a heterogenous disease, in which the role of bacterial overgrowth and recurrence of inflammatory bowel disease must be clarified.  相似文献   

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J型回肠贮袋肛管吻合术在全结肠切除中的应用   总被引:1,自引:0,他引:1  
目的:探讨全结肠切除术后J型回肠贮袋肛管吻合的价值。方法:对近5年16例全结肠切除病人应用J型回肠贮袋肛管肛管吻合术进行分析总结。结果:该术式并发症少,无一例回肠肛管吻合口瘘发生,肛门功能良好,无夜间漏便,大便次数平均3-5次/d,夜间0-1次,无贮袋炎发生,病人对生活质量感到满意。全组病人随访1-5年,无恶变发生。结论:全结肠切除J型回肠贮袋肛管吻合术能有效地预防吻合口瘘,贮袋炎,且肛门功能好,手术操作相对简便易行,只要指征选择适当,该术式是一种较为理想的手术方法。  相似文献   

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Anorectal manometry is the basic investigation for the study of anorectal function. The lack of a standard execution technique and of any common definition of the manometric parameters constitutes a major limitation. The aim of the present study is to propose a standard technique for performing manometry. In addition we also focus on those manometric parameters that are easily identified and interpreted for the systematic study of a proctological patient. The protocol used is organised in three phases: (i) tests with a radial channel probe with continuous extraction, which provide information on the length of the anal canal and on the precise site of maximum pressure; (ii) tests with a radial channel probe with stationary extraction, which does not involve reflex contraction of the sphincter apparatus and therefore permits better evaluation of sphincter pressure when the muscles are relaxed as well as the identification of slow and ultra-slow waves; (iii) tests with a helicoidal probe and a balloon for the evaluation of the anorectal inhibitory reflex and of anorectal sensitivity. Using this protocol it is possible to perform manometry in less than 30 minutes and to define the importance of anorectal function with approximately 10 parameters which are easily identified and interpreted.  相似文献   

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The procedure of total colectomy, excision of the rectal mucosa and ileo-anal anastomosis with or without a proximal small intestinal reservoir has been described as a method of treating patients with ulcerative colitis and familial polyposis coli. The purpose of constructing a terminal ileal reservoir is to reduce the severe diarrhoea which often occurs following ileo-anal anastomosis. It is suggested that the use of a single antiperistaltic segment for this purpose would reduce the diarrhoea, and provide continence. This has been tested in the dog and the results are reported in this publication.  相似文献   

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Endorectal ileo-anal anastomosis has become a mainstay of continent bowel reconstruction after total colectomy. However, the procedure is often aborted because of lack of vessel length for the formation of the ileal pouch. The use of microsurgical techniques to lengthen mesenteric vessels and to allow completion of this valuable procedure is reported.  相似文献   

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The incidence of relaxation of the pelvic floor increases with age, and although a relation between propapse and the decline of estrogens has been suggested, there is no objective evidence. Together with urodynamic measurements, anal manometry is one of the few ways of making an objective assessment of the strength of pelvic structures located in and near the pelvic floor. In order to study the role of estrogens, anal manometry was performed before, during and after estrogen replacement therapy with daily oral use of 0.625 mg conjugated estrogens for 6 months. Five postmenopausal women, who had not used estrogen replacement therapy in the past, were included in the study. None of the manometric parameters, including maximal anal resting pressure, maximal squeeze pressure and internal anal sphincter response, changed. It was concluded that estrogens have no effects on manometric parameters of the external sphincter and that anal manometry may not be the appropriate method to assess the effects of estrogens on the pelvic floor.EDITORIAL COMMENT: This is a small, concise and well designed study. The results show that estrogens — as in urodynamics — have no measurable effects on anal pressure. We still do not quite understand the mechanisms by which estrogens exert beneficial action on the pelvic structures.  相似文献   

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Six patients with polyposis coli and five with chronic ulcerative colitis underwent total colectomy and mucosal proctectomy with preservation of the anal sphincter and levator ani muscle. An ileal reservoir, constructed from the terminal ileum, is brought out through the anal sphincter for anastomosis to to the anus at the dentate line. Two patients in the series had a three-limb reservoir with anastomosis of a short efferent ileal limb to the anus (Parks technique). Nine patients had a two-limb J-shaped reservoir with the apex of the reservoir anastomosed to the anus (Utsunomiya technique). All patients had a temporary defunctioning ileostomy. There were no deaths. Two patients suffered from severe infection within the rectal muscle cuff. One resolved completely with spontaneous drainage into the reservoir; the other had continuing sepsis and eventually required excision of the anus and conversion to a continent ileostomy. All patients remain in good general condition with no disturbance of urinary or sexual function. Continence is satisfactory in all patients but two wear a pad at night. All evacuate their reservoirs spontaneously: none requires the use of a catheter. For most patients stool frequency varies from four to eight times daily but two patients have more frequent bowel motions. Colitis patients have more frequent bowel activity than those with polyposis. Three patients take Imodium tablets to lessen bowel frequency. The operation should be reserved for specialized centres and is still under trial; however, it appears likely to become the operation of choice for all patients with polyposis coli and for many patients with chronic ulcerative colitis.  相似文献   

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目的研究盆底痉挛(pelvic floor dyssynergia,PFD)的肛管直肠动力学变化。方法对有便秘症状并经排粪造影诊断为PFD的21例患者用肛管直肠动力检测仪行肛管直肠压力测定,并测定会阴下降和直肠排空率。以无排便功能紊乱症状的12例健康志愿者作对照组。结果与对照组相比,PFD肛管静息压升高(P<0.05),力排时直肠-肛管压力差明显下降(P<0.01),且此压力差为负值,引起直肠初始感觉和初始便意感觉的容积均明显升高(P<0.01),直肠肛门抑制反射(rectal anal inhib-itory reflex,RAIR)阈值容积和直肠排空率均明显下降(P<0.01)。PFD的RIAR阈值容积与引起直肠初始感觉的容积呈正相关(P<0.01)。PFD力排时的会阴下降幅度下降(P<0.05)。结论PFD存在明显的直肠感觉功能下降和盆底肌肉协调运动障碍。  相似文献   

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盆底痉挛21例肛直肠动力学研究   总被引:3,自引:0,他引:3  
目的研究盆底痉挛(pelvic floor dyssynergia,PFD)的肛管直肠动力学变化。方法对有便秘症状并经排粪造影诊断为PFD的21例患者用肛管直肠动力检测仪行肛管直肠压力测定,并测定会阴下降和直肠排空率。以无排便功能紊乱症状的12例健康志愿者作对照组。结果与对照组相比,PFD肛管静息压升高(P〈0.05),力排时直肠-肛管压力差明显下降(P〈0.01),且此压力差为负值,引起直肠初始感觉和初始便意感觉的容积均明显升高(P〈0.01),直肠肛门抑制反射(rectal anal inhibitory reflex,RAIR)阈值容积和直肠排空率均明显下降(P〈0.01)。PFD的RIAR阈值容积与引起直肠初始感觉的容积呈正相关(P〈0.01)。PFD力排时的会阴下降幅度下降(P〈0.05)。结论PFD存在明显的直肠感觉功能下降和盆底肌肉协调运动障碍。  相似文献   

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