结肠切除术治疗顽固性便秘的临床研究

目的：探讨顽固性便秘的病因及有效的诊治方法。方法：对正常人及便秘患者进行对照研究，行肠道转运、肛肠动力学、盆底电生理及排粪造影检查。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，便秘组肠道转运时间延长；直肠感觉功能降低；模拟排便时盆底肌抑制能力下降。部分患者伴盆腔器官松弛。病理示结肠纲间神经丛细胞减少、变性。术后平均随访３３．１个月，手术有效率达９２．９％。结论：顽固

Clinical study on colectomy for the treatment of obstinate constipation

Objective: To investigate the pathogenesis, dignosis criteria and the therapeutic method of constipated patients specialized with decreasing of stool frequency. Methods: History recording, bowel transit, anorectal dynamic,electromyography of the pelvic floor and defecography were performed before subtotal or total colectomy for the severe constipation. Results: The natural stool frequency decreased, the time of bowel transit was delayed, the rectal sensation and the ability of reflect inhibition of the pelvic floor when attempting to defecate were damaged significantly compared with the normal controls. pathology showed that the argyrophilic neurons in the myentenic and submucous plexus reduced quantitively. All the patients were followed up for avarage of 33.1 monthes.the operation produces a satisfactory functional outcome in 92.9% of the patients undergoing operation. Conclusion:The disorder refering to the study belong to the disease of severe damage to the colon transit function duo to the impairment of the myentenic and submucous plexus of the colon. Diagnosis of the disease rely on the typical clinic features and the bowel transit test, removing the pathologic colon can effectively alleviate constipation.