陰部神経伝導時間の遅延程度からみたJ型回腸嚢肛門吻合術後におけるsoilingの病態生理学的検討
潰瘍性大腸炎でJ型回腸嚢肛門吻合術を受けた15症例 (回腸瘻閉鎖術後2年目; 男性10例, 女性5例, 22～57歳, 平均40.2歳) について, 体表手術症例16例 (A群)(男性10例, 女性6例, 18～50歳, 平均38.9歳) を対照に用い, soilingを認めない5症例 (B群), 水様便時のみsoilingを認める5症例 (C群), 便性に関係無くsoiling を認める5症例 (D群) の4群に分類し, 陰部神経伝導時間値を比較検討した. その結果, 1) 陰部神経伝導時間は, 全症例において左右無く測定された. 2) D群はA, B, C群より有意に延長していた (それぞ...
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| Published in | 日本消化器外科学会雑誌 Vol. 34; no. 11; pp. 1582 - 1586 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本消化器外科学会
01.11.2001
一般社団法人日本消化器外科学会 The Japanese Society of Gastroenterological Surgery |
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| Online Access | Get full text |
| ISSN | 0386-9768 1348-9372 |
| DOI | 10.5833/jjgs.34.1582 |
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| Abstract | 潰瘍性大腸炎でJ型回腸嚢肛門吻合術を受けた15症例 (回腸瘻閉鎖術後2年目; 男性10例, 女性5例, 22～57歳, 平均40.2歳) について, 体表手術症例16例 (A群)(男性10例, 女性6例, 18～50歳, 平均38.9歳) を対照に用い, soilingを認めない5症例 (B群), 水様便時のみsoilingを認める5症例 (C群), 便性に関係無くsoiling を認める5症例 (D群) の4群に分類し, 陰部神経伝導時間値を比較検討した. その結果, 1) 陰部神経伝導時間は, 全症例において左右無く測定された. 2) D群はA, B, C群より有意に延長していた (それぞれ, p<0.01). 3) C群はA, B群より有意に延長していた (それぞれ, p<0.05). 4) A, B群間に有意差は認めなかった. 以上のことより, 陰部神経伝導時間が遅延を来すほど, soilingを悪化させることが示唆された. |
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| AbstractList | 潰瘍性大腸炎でJ型回腸嚢肛門吻合術を受けた15症例(回腸瘻閉鎖術後2年目;男性10例, 女性5例, 22〜57歳, 平均40.2歳)について, 体表手術症例16例(A群)(男性10例, 女性6例, 18〜50歳, 平均38.9歳)を対照に用い, soilingを認めない5症例(B群), 水様便時のみsoilingを認める5症例(C群), 便性に関係無くsoilingを認める5症例(D群)の4群に分類し, 陰部神経伝導時間値を比較検討した.その結果, 1)陰部神経伝導時間は, 全症例において左右無く測定された.2)D群はA, B, C群より有意に延長していた(それぞれ, p<0.01).3)C群はA, B群より有意に延長していた(それぞれ, p<0.05).4)A, B群間に有意差は認めなかった.以上のことより, 陰部神経伝導時間が遅延を来すほど, soilingを悪化させることが示唆された.
Fifteen patients with uldcerative colitis after total colectomy, mucosal proctectomy, and ileal J pouch-anal anastomosis were neurophysiologically studied and compared with 16 healthy controls(A group ; 10 men and 6 women, aged 18〜50 years with a mean age of 38.9 years). All of 15 patients(10 men and 5 women, aged 22〜57 years with a mean age of 40.2 years)were divided into 3 groups(Group B ; 5 patients without soiling, Group C ; 5 patients with soiling at watery diarrhea, Group D ; 5 patients with soiling every day). The latency of response in the external anal sphincter muscle following digitally directed transrectal pudendal nerves(pudendal nerve terminal motor latency ; PNTML)was measured. Following results were obtained. 1)The conduction delay of bilateral PNTML was signifivantly longer in group D than that in group A, B, and C(p<0.01, respectively). 2)The conduction delay of bilateral PNTML was significantly longer in group C than that in group A and B(p<0.05, respectively). 3)The conduction delay of bilateral PNTML in group B was longer than that in group A. But there was no significant difference between the group A and B. These findings suport the hypothesis that the conduction delay of PNTML in the patients with UC may be caused by surgical demage to pudendal nerves. The degree of the conduction delay of bilateral PNTML correlated well with the symptom of soiling. 潰瘍性大腸炎でJ型回腸嚢肛門吻合術を受けた15症例 (回腸瘻閉鎖術後2年目; 男性10例, 女性5例, 22～57歳, 平均40.2歳) について, 体表手術症例16例 (A群)(男性10例, 女性6例, 18～50歳, 平均38.9歳) を対照に用い, soilingを認めない5症例 (B群), 水様便時のみsoilingを認める5症例 (C群), 便性に関係無くsoiling を認める5症例 (D群) の4群に分類し, 陰部神経伝導時間値を比較検討した. その結果, 1) 陰部神経伝導時間は, 全症例において左右無く測定された. 2) D群はA, B, C群より有意に延長していた (それぞれ, p<0.01). 3) C群はA, B群より有意に延長していた (それぞれ, p<0.05). 4) A, B群間に有意差は認めなかった. 以上のことより, 陰部神経伝導時間が遅延を来すほど, soilingを悪化させることが示唆された. |
| Author | 富田, 凉一 福澤, 正洋 藤崎, 滋 池田, 太郎 朴, 英智 丹正, 勝久 |
| Author_FL | IKEDA Tarou TOMITA Ryouichi TANJOH Katuhisa PARK Eichi FUJISAKI Shigeru FUKUZAWA Masahiro |
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| DocumentTitleAlternate | Pathophsiological Study on Terminal Motor Latency in the Pudendal Nerve for Ulcerative Colitis after Ileal J Pouch-Anal Anastomosis with or without Soiling |
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| References | 22) Rasmussen O, Christiansen J, Tetzchner T et al: Pudendal nerve function in idiopathic fecal incontinence. Dis colon rectum 43: 633-637, 2000 9) Neilly P, Neill ME, Hill G: Restorative protectomy with ileal pouch-anal anastomosis in 203 patients. Aust N Z J Surg 69: 22-27, 1999 13) Ho YH, Goh HS: The neurophysiological significance of pertoneal descent. Int J colorectal Dis 10: 107-111, 1995 5) Hatakeyama K, Shimamura K, Muto T et al: Defecating function after ileal W pouch-anal anastomosis for restorative protectocolectomy: an evaluation by age. Acta Med Biol 39: 181-184, 1991 8) 荒井勝彦, 杉田昭, 山内毅ほか: 潰瘍性大腸炎に対する大腸全摘, J型回腸嚢肛門吻合術と肛門管吻合術後の排便機能. 日消外会誌28: 1814-1818, 1995 4) Nicholls RJ, Pezim ME: Restorative proctocolectomy with ileal reservoir for ulcerative colitis and familial adenomatous polyposis: a comparision of three reservoir designs. Br J Surg 72: 470-474, 1985 2) 宇都宮譲二, 岩間毅夫, 今城真人ほか: 全結腸切除直腸粘膜切除回腸肛門吻合術: 序説. 外科診療21: 268-280, 1979 10) Tomita R, Kurosu Y, Munakata K: Electrophysiologic assessments in pudendal and sacral motor nerves after ileal J pouch-anal anastomosis for patients with ulcerative colitis and adenomatosis coli. Dis Colon Rectum 39: 410-415, 1996 6) 馬場正三, 中井勝彦, 倉橋隆之: 大腸全摘後のJ-pouchによる回腸肛門吻合術. 臨外48: 193-200, 1993 17) Kafka NJ, Barrett RC, Murray JJ et al: Pudendal neuropathy is the only parameter differentiating leakage form solid stool incontinence. Dis Colon Rectum 40: 1220-1227, 1997 16) Pfeifer J, Salanga VD, Agachan F et al: Variation in pudendal nerve terminal motor latency according to disease. Dis Colon Rectum 40: 79-83, 1997 23) Williams: Faecal incontinence. Edited by Kumar D, David J, Waldron DJ et al: Clinical measurement in coloproctology. First edition. Springer-Verlag, London, 1991, p109-115 15) Rieger NA, Sarre RG, Saccone GT et al: Correlation of pudendal nerve terminal motor latency with the results of anal manometry. Int Colorectal Dis 12: 303-307, 1997 21) Teztschner T, Sorensen M, Jonsson L et al: Delivery and pudendal nerve function. Acta Obstet Gynecol Scand 76: 324-331, 1997 12) Kiff ES, Swash M: Slowed conduction in the pudendal nerves in idiopathic (neurogenic) faecal incontinence. Br J Surg 71: 614-616, 1984 18) Leroi AM, Dorival MP, Lecouturier MF et al: Pudendal neiropathy and severity of incontinence but not presence of an anal sphincter defect may determine the response to biofeedback therapy in fecal incontinence. Dis Colon Rectum 42: 762-769, 1999 1) Ravitch MM, Sabiston DC: Anal ileostomy with preservation of the sphincter;Aptoposed operation in patients requiring total colectomy for benign lesions. Surg Gynecol Obstet 84: 1095-1099, 1947 7) 富田凉一, 黒須康彦, 五十棲優ほか: 内圧検査からみた回腸肛門吻合術後soiling症例についての病態生理学的検討. 日消外会誌27: 2551-2556, 1994 20) Sangwan YP, Coller JA, Robert PL et al: Unilateral pudendal neuropathy. Dis Colon Rectum 39: 249-251, 1996 3) Parks AG, Nicholls RJ, Belliveau P: Proctocolectomy with ileal reservoir and anal anastomosis. Br J Srug 67: 533-538, 1980 11) Marcio J, Jorge N, Wexner SD et al: Recovery fo anal sphincter function after the ileoanal reservoir procedure in patients over the age of fifty. Dis colon Rectum 37: 1002-1005, 1994 14) Snooks SJ, Barnes PRH, Swash M: Damage to the innervation of the voluntary anal and periurethral sphincter musclature in incontinence: an electrophysiological study. J Neurol Neurosurg Psychiatry 47: 1269-1273, 1984 19) Voyvodic F, Schloithe AC, Wattchow DA et al: Delayed pudendal nerve conduction and endosonographic appearance of the anal sphincter complex. Dis Colon Rectum 43: 1689-1694, 2000 |
| References_xml | – reference: 6) 馬場正三, 中井勝彦, 倉橋隆之: 大腸全摘後のJ-pouchによる回腸肛門吻合術. 臨外48: 193-200, 1993 – reference: 22) Rasmussen O, Christiansen J, Tetzchner T et al: Pudendal nerve function in idiopathic fecal incontinence. Dis colon rectum 43: 633-637, 2000 – reference: 7) 富田凉一, 黒須康彦, 五十棲優ほか: 内圧検査からみた回腸肛門吻合術後soiling症例についての病態生理学的検討. 日消外会誌27: 2551-2556, 1994 – reference: 20) Sangwan YP, Coller JA, Robert PL et al: Unilateral pudendal neuropathy. Dis Colon Rectum 39: 249-251, 1996 – reference: 1) Ravitch MM, Sabiston DC: Anal ileostomy with preservation of the sphincter;Aptoposed operation in patients requiring total colectomy for benign lesions. Surg Gynecol Obstet 84: 1095-1099, 1947 – reference: 3) Parks AG, Nicholls RJ, Belliveau P: Proctocolectomy with ileal reservoir and anal anastomosis. Br J Srug 67: 533-538, 1980 – reference: 13) Ho YH, Goh HS: The neurophysiological significance of pertoneal descent. Int J colorectal Dis 10: 107-111, 1995 – reference: 8) 荒井勝彦, 杉田昭, 山内毅ほか: 潰瘍性大腸炎に対する大腸全摘, J型回腸嚢肛門吻合術と肛門管吻合術後の排便機能. 日消外会誌28: 1814-1818, 1995 – reference: 12) Kiff ES, Swash M: Slowed conduction in the pudendal nerves in idiopathic (neurogenic) faecal incontinence. Br J Surg 71: 614-616, 1984 – reference: 23) Williams: Faecal incontinence. Edited by Kumar D, David J, Waldron DJ et al: Clinical measurement in coloproctology. First edition. Springer-Verlag, London, 1991, p109-115 – reference: 16) Pfeifer J, Salanga VD, Agachan F et al: Variation in pudendal nerve terminal motor latency according to disease. Dis Colon Rectum 40: 79-83, 1997 – reference: 10) Tomita R, Kurosu Y, Munakata K: Electrophysiologic assessments in pudendal and sacral motor nerves after ileal J pouch-anal anastomosis for patients with ulcerative colitis and adenomatosis coli. Dis Colon Rectum 39: 410-415, 1996 – reference: 9) Neilly P, Neill ME, Hill G: Restorative protectomy with ileal pouch-anal anastomosis in 203 patients. Aust N Z J Surg 69: 22-27, 1999 – reference: 14) Snooks SJ, Barnes PRH, Swash M: Damage to the innervation of the voluntary anal and periurethral sphincter musclature in incontinence: an electrophysiological study. J Neurol Neurosurg Psychiatry 47: 1269-1273, 1984 – reference: 4) Nicholls RJ, Pezim ME: Restorative proctocolectomy with ileal reservoir for ulcerative colitis and familial adenomatous polyposis: a comparision of three reservoir designs. Br J Surg 72: 470-474, 1985 – reference: 18) Leroi AM, Dorival MP, Lecouturier MF et al: Pudendal neiropathy and severity of incontinence but not presence of an anal sphincter defect may determine the response to biofeedback therapy in fecal incontinence. Dis Colon Rectum 42: 762-769, 1999 – reference: 15) Rieger NA, Sarre RG, Saccone GT et al: Correlation of pudendal nerve terminal motor latency with the results of anal manometry. Int Colorectal Dis 12: 303-307, 1997 – reference: 11) Marcio J, Jorge N, Wexner SD et al: Recovery fo anal sphincter function after the ileoanal reservoir procedure in patients over the age of fifty. Dis colon Rectum 37: 1002-1005, 1994 – reference: 5) Hatakeyama K, Shimamura K, Muto T et al: Defecating function after ileal W pouch-anal anastomosis for restorative protectocolectomy: an evaluation by age. Acta Med Biol 39: 181-184, 1991 – reference: 19) Voyvodic F, Schloithe AC, Wattchow DA et al: Delayed pudendal nerve conduction and endosonographic appearance of the anal sphincter complex. Dis Colon Rectum 43: 1689-1694, 2000 – reference: 17) Kafka NJ, Barrett RC, Murray JJ et al: Pudendal neuropathy is the only parameter differentiating leakage form solid stool incontinence. Dis Colon Rectum 40: 1220-1227, 1997 – reference: 2) 宇都宮譲二, 岩間毅夫, 今城真人ほか: 全結腸切除直腸粘膜切除回腸肛門吻合術: 序説. 外科診療21: 268-280, 1979 – reference: 21) Teztschner T, Sorensen M, Jonsson L et al: Delivery and pudendal nerve function. Acta Obstet Gynecol Scand 76: 324-331, 1997 |
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| Snippet | 潰瘍性大腸炎でJ型回腸嚢肛門吻合術を受けた15症例 (回腸瘻閉鎖術後2年目; 男性10例, 女性5例, 22～57歳, 平均40.2歳) について, 体表手術症例16例 (A群)(男性10例, 女性6... 潰瘍性大腸炎でJ型回腸嚢肛門吻合術を受けた15症例(回腸瘻閉鎖術後2年目;男性10例, 女性5例, 22〜57歳, 平均40.2歳)について, 体表手術症例16例(A群)(男性10例, 女性6例,... |
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| SubjectTerms | ileal J puch-anal anastomosis pathophysiology pudendal nerve motor terminal latency soiling ulcerative colitis |
| Title | 陰部神経伝導時間の遅延程度からみたJ型回腸嚢肛門吻合術後におけるsoilingの病態生理学的検討 |
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| ispartofPNX | 日本消化器外科学会雑誌, 2001, Vol.34(11), pp.1582-1586 |
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