结肠次全切除联合改良Duhamel术式治疗重度功能性便秘

Combined Use of Subtotal Colectomy and Modified Duhamel Procedure in the Surgical Treatment of Severe Functional Constipation

目的探讨结肠次全切除联合改良Duhamel术式治疗重度功能性便秘的临床效果。方法对2008年7月-2010年2月在东南大学医学院附属徐州医院采用结肠次全切除联合改良Duhamel术式治疗33例重度功能性便秘的临床资料进行回顾性分析,观察患者术后并发症及肠道功能恢复情况,随访术后1年患者的生活质量及排便情况。结果所有患者手术顺利,平均手术时间(220±47)min,术中出血50～120 ml,术后平均通气时间(47±19)h,术后1年,26例患者便秘症状完全缓解(大便次数1～3次/d),6例腹泻(大便次数4～8次/d),1例患者轻度便秘复发(3～5 d一次),30例患者对术后排便感觉满意。结论结肠次全切除联合改良Duhamel术式治疗重度功能性便秘安全可行,临床效果较好,能有效地提高患者生活质量,值得临床推广。

Objective To evaluate the treatment of subtotal colectomy and modified Duhamel procedure for severe functional constipation. Methods 33 patients with severe functional constipation received subtotal colectomy combined with modified Du- hamel procedure during July 2008 to February 2010 were retrospectively analyzed. The complications and the time of intestinal function recovery after operation were observed. Follow-up the patient＇ s quality of life and defecate after one year. Results One year later, the symptoms of constipation were significantly alleviated （defecation 1 -3 times/d） in 26 patients ;6 cases had various degrees of diarrhea （ defecation 4 - 8 times/d） ; and 1 patient showed recurrence of mild constipation （ defecation 1 time/3 - 5 d）. Thirty cases were satisfied with their frequency of defecation. All the operations were successfully completed. The mean operation time was（220 ±47） min. The estimated operative blood loss was 50 ml to 120 ml. The time to resume intestinal function was （47 ±19）h. Conclusion The subtotal colectomy combined with modified Duhamel procedure was a practicable and effective op- tion for severe functional constipation, and it can effectively improve the quality of life of the patients. The procedure was worth being wildly used.