| Objective: To investigate the effect of subtotal proctocolectomy and modified Duhamel anastomosis on anal function in patients with slow transit constipation complicated with adult megacolon.Methods:The clinical data of 80 patients with slow transit constipation complicated with adult giant colon treated by subtotal proctocolectomy and modified Duhamel anastomosis in Hunan people’s Hospital from December 2007 to December 2017 were collected and divided into two groups according to the mode of operation: group A(n=28)underwent total colectomy and upper rectal resection,ileal pouch J-Pouch and lower rectal modified Duhamel anastomosis+ileostomy,group B(n=52)underwent subtotal colectomy(preserved ileocecum and partial ascending colon),upper rectal resection,ascending colon and lower rectal modified Duhamel anastomosis + ileostomy.The results of Wexner constipation score,anal function Kirwan grade and rectoanal manometry before operation and 3months,6 months,1 year,2 years and 3 years after operation were summarized and analyzed.Result: 1.The Wexner constipation score: The scores at 6 months(11.4±0.5 in group A,6.9 ±1.8 in group B),12 months(9.6 ±0.7 in group A,6.0±1.4 in group B),24 months(6.7 ±0.6 in group A,4.4 ±0.7 in group B),36months(4.7 ±0.7 in group A,3.9 ±0.8 in group B)after operation were significantly lower than those before operation(21.3 ±3.0 in group A,20.1±3.2 in group B)(P<0.01).The scores of Wexner constipation at 6 months,12 months,24 months and 36 months after operation in group B were significantly lower than those in group A(P<0.01).2.Kirwan grade of anal function: 3 months after operation,there were 0 cases of grade I and 28 cases of grade II-IV in group A,9 cases of grade I and 43 cases of grade IIIV in group B.6 months after operation,there were 5 cases of grade I,23 cases of grade II-IV in group A,42 cases of grade I and 10 cases of grade II-IV in group B.12 months after operation,there were 19 cases of grade I,9 cases of grade II-IV,46 cases of grade I and 6 cases of grade II-IV in group B.The anal defecation control was weaker than that before operation(28 cases of grade I in group An and 52 cases of grade I in group B)(P<0.05).24 months after operation,there were 24 cases of grade I and 4cases of II-IV in group A,48 cases of grade I and 4 cases of grade II-IV in group B.36 months after operation,26 cases of grade I and 2 cases of grade II-IV in group A,49 cases of grade I and 3 cases of grade II-IV in group B.There was no difference between 24 months and 36 months after operation and before operation(P<0.05).The grade of group B was lower than that of group A at 3 months,6 months and 12 months after operation(P<0.05).3.The positive rate of rectoanal inhibitory reflex in the two groups(group A:1/28,group B:9/52)was no significant difference compared with that before operation(group A:2/28,group B:10/52)(P>0.05).The positive rate at 6 months(group A:8/28,group B:27/52),12months(group A:8/28,group B:28/52),24 months(group A:9/28,group B:29/52),36 months(group A:9/28,group B:29/52)was higher than that before operation(P<0.05).The positive rate of group B was higher than that of group A at 6 months,12 months,24 months and 36 months after operation(P<0.05).4.The average resting pressure of anal canal at 3 months after operation(group A 32.8±9.0,115.2±6.7,group B37.3±7.3,127.3±12.8)were significantly lower than those before operation(group A 43.6±6.1,140.7±39.7,group B 46.4±7.7,142.6±21.7)(P<0.01),And 6 months after operation(group A 46.7±8.2,156.8±11.8,group B55.6±8.8,166.0±25.3),12 months after operation(group A 59.0±9.5,159.9±12.0,group B 64.1±8.7,170.7±25.1),24 months after operation(group A 63.3±9.4,168.9±11.8,group B 65.5±8.8,171.2±27.8),36 months after operation(group A 65.2±8.5,170.0±11.9,group B 68.3±8.6,172.7±24.8)was significantly higher than that before operation(P<0 01).The average resting pressure of anal canal in group A was lower than that in group B at 3 months,6 months and 12 months after operation(P<0.05).Conclusion:1.The anal defecation control function of patients with slow transit constipation complicated with adult megacolon underwent modified Duhamel anastomosis after subtotal colectomy: the function of anal defecation was significantly weakened 3 months after operation.Patients in the ileocecum and partial ascending colon preserved group were better than those in total colectomy group at 6 months and 12 months after operation,and 81.25% and90% of the patients achieved normal stool control respectively,and there was no incontinence at 24 months and 36 months after operation.The anal defecation function of the two groups was normal and defecation was unobstructed.2.Prophylactic ileostomy can improve the ability of anal defecation control and play a positive role in the protection of anal function. |
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