Colectomy for idiopathic megarectum and megacolon.
Colectomy for idiopathic megarectum and megacolon.
复制标题
特发性巨直肠和巨结肠的结肠切除术。
作者：
G. Stabile;M. Kamm;P. Hawley;J. Lennard
对40例18年来因特发性巨结肠和巨直肠行结肠切除术的患者的结局进行了评价。所有患者的放射学检查均显示肠道扩张，排便频率低于每周2次。22例患者行盲肠直肠吻合术，11例患者行回肠直肠吻合术（包括1例既往行盲肠直肠吻合术和4例既往行乙状结肠切除术），7例患者行乙状结肠切除术。手术时的平均（范围）年龄为35（17-69）岁。所有三种手术导致超过80%的患者排便频率正常，但回肠直肠吻合术患者均未发生复发性便秘。34例患者术前出现疼痛，14例患者术后仍存在疼痛。1名患者死亡，4名患者因肠梗阻需要随后进行剖腹手术。全结肠扩张患者和左结肠扩张患者的功能结局无差异。3名患者随后因便秘接受了手术。结肠切除术是治疗特发性巨结肠的有效方法，其并发症少，回直肠吻合术是首选术式。
The outcome in 40 patients who underwent colectomy for idiopathic megacolon and megarectum over an 18 year period was evaluated. All patients had a radiologically dilated bowel and a bowel frequency of less than two per week. Twenty two patients had a caecorectal anastomosis, 11 had an ileorectal anastomosis (including one with a previous caecorectal anastomosis and four with a previous sigmoid resection), and seven had a sigmoid resection. The mean (range) age at operation was 35 (17-69) years. All three operations resulted in a normal bowel frequency in more than 80% of patients but no patient with an ileorectal anastomosis experienced recurrent constipation. Thirty four patients experienced pain preoperatively and this was still present in 14 patients postoperatively. One patient died and four required subsequent laparotomy for bowel obstruction. The functional outcome in patients with dilatation of the whole colon and in those with dilatation of the left colon did not differ. Subsequent surgery for constipation was performed in three patients. Colectomy offers good results with few complications in the treatment of idiopathic megacolon, and an ileorectal anastomosis is the preferred operation.