Studies Onpathophysiology After Total Colectomy, Mucosal Proctectomy and Ileoanal Anastoniosis.

全结肠切除、直肠黏膜切除和回肠肛管吻合术的病理生理学研究J.宇都宫，医学博士，山村，医学博士，医学博士，黑木，医学博士，H.Natori，医学博士，Y.Sakanoue，医学博士和K.Kusuhara，医学博士兵库医学院外科)这项研究的目的是了解回肠肛门吻合术(IAA)后患者的肠道功能的生理背景，并弄清患者的代谢变化，以便建立实用的操作程序，从而提供患者可以接受的生活质量。自1979年以来，宇都宫等在东京进行了49例J袋肛门吻合术，其中溃疡性结肠炎(UC)11例，结肠腺瘤性息肉病(APC)38例。1983年以后，兵库对J袋肛门吻合术作了进一步改进，共收治患者94例(UC 56例，APC 36例，其他2例)。直肠下腹膜下段(中袖)保留肌袖的…与“最小”直肠袖套切除提升器上方的直肠袖带相比，更多的REE显示出更好的临床功能效果，以及更好地保存静息和挤压肛门压力。为了成功地进行如此广泛的黏膜切除术，我们设计的手术程序包括在俯卧折刀位置使用“钳子凝固术”。血流动力学检查显示，患者在改变体位时没有明显的缺点。与通过分离回结肠动脉而形成的短J袋相比，具有双侧血供的原始J袋在袋尖的循环血量增加了24%。已制定了心理、临床和生理方面的标准，以便对晚期结果进行客观比较研究。IAA患者的水、电解质和胆汁酸的代谢状态介于回肠末端造口患者和自然肛门排泄者之间。较少

Studies on pathophysiology after total colectomy, mucosal proctectomy and ileoanal anastomosis J. Utsunomiya, M. D., T. Yamamura, M. D., M. Kusuoniki, M. D., T. Kuroki, M. D., H. Natori, M. D., Y. Sakanoue, M. D., and K. Kusuhara, M. D. (Second Dept. of Surgery, Hyogo College of Medicine)Aims of the study are to understand physiological background of bowel function and to clarify metabolic alternation in the patient after ileoanal anastomosis (IAA) in order to establish the practical procedure, which can provide the quality of life acceptable to the patients. The J-pouch anal anastomosis that had been developed by Utsunomiya J. in Tokyo through his experiences on 49 cases including 11 ulcerative colitis (UC) and 38 adenomatous polyposis coli (APC) since 1979 were further improved after 1983 in Hyogo to accumulate a new series of 94 patients (56 UC, 36 APC and 2 others). The patients with the muscular cuff that were preserved on the subperitoneal lower rectal portion (the medium cuff) w … More ere found to show a superior clinical functional result as well as better preserved resting and squeeze anal pressure comparing with those with the "minimum" rectal cuff in which the cuff was excised above the levator. For succeeding in such an extensive mucosectomy, the procedure which was devised by us included the "forceps coagulating technique" at the prone jackknife position. Hemodynamic study revealed no significant demerit during changing position of the patient. The original J-pouch with bilateral blood supplies was found to have a 24% increase in circulating blood volume in the pouch apex comparing with the short J-pouch that was created by dividing the ileocolic artery. The criteria for psychological, clinical as well as physiological aspects have been developed for objective comparative study on the late result. The metabolic states of water, electrolytes and bile acids in the patients with IAA were found to be situated in between those of the patients with terminal ileostomy and of the individual with a natural anal excretion. Less