<原著>直腸癌外科における術後排便機能障害の病態生理に関する実験的研究
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It is known that the postoperative anorectal dysfunction after sphincter-saving resection for rectum cancer is caused by complex of many factors, such as (1) loss of the reservoir function of the rectum, (2) functional disorder of the pelvic floor muscles and the internal anal sphincter, (3) disappearances of anorectal reflex and of sensation at the anal canal. The purpose of this study is to clarify the mechanism of the postoperative dysfunction and to find out the effective countermeasure for the dysfunction. Experiments were focused to resolve the influences of (1) the denervation of hypogastric and sacral nerves and (2) the resection of the rectum on anorectal function. Experiments were carried out on 16 dogs. Anorectal pressure was measured by the infused open-tip method and the internal sphincter electromyography (EMG) with bipolar spine electrodes simultaneously, under general pentobarbital anesthesia. Colonic motility was measured with a strain gauge transducer in the conscious state. These measurements were executed before and after (1) the hypogastric and/or sacral nerve section and (2) the rectal resection. Combined resection of the hypogastric and sacral nerves yielded neither positive effects on the anal canal resting pressure nor on the internal sphincter activity, and the ano-rectal reflex maintained. However, the internal sphincteric relaxation became prolonged distinctively than that of the preoperative dogs. Slushy feces and frequent bowel movements were the common complications after surgery in dogs similarly to man. Mechanotransducers fixed on the colon, spine metal electrodes penetrated into the internal sphincter and the manometric probe were the major instruments used. The abnormal colonic motility occurred irregularly corresponding to the increases in the discharge frequencies as well as in the amplitude of colonic contraction after rectal resection. These abnormal colonic hypermotility was predominant in the distal colon above the colo-rectal anastmosis towards the oral side. The hypermotility and the increased electrical activity disappeared as the lapse of the time, and the clinical anorectal dysfunction was improved. On the other hand, rectal compliance (△V/△P) remained in lower values and showed no improvement even in 5 weeks after rectal resection. These findings suggest that the spastic colonic contraction in the distal colon above the colorectal anastomosis was effected greatly on the postoperative dysfunction of the internal sphincter and the disturbance of the defecation which was induced directly or secondary by the sphincter-saving resection for the rectum carcinoma.
- 近畿大学の論文
- 1986-06-25
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