腹腔镜结肠次全切除逆蠕动盲直肠吻合术治疗慢传输型便秘长期疗效观察

Long-term outcomes of laparoscopic subtotal colectomy with antiperistaltic cecorectal anastomosis in treating slow transit constipation

目的观察腹腔镜结肠次全切除逆蠕动盲直肠吻合术治疗慢传输型便秘的远期临床效果。方法回顾性分析2007年4月至2009年12月中国人民解放军第150中心医院40例行腹腔镜结肠次全切除逆蠕动盲直肠吻合术治疗慢传输型便秘病人的临床资料,收集手术时间、术中出血量、首次排气排便时间、住院时间及术后并发症做为手术恢复的指标,对比观察术前与术后3、6、12、24个月的Wexner便秘评分(WCS),胃肠生活质量指数(GIQLI)等情况。结果所有病人均顺利进行腹腔镜手术,无中转开腹,发生2例肺部感染,2例不全性肠梗阻;术后第3、6、12、24个月WCS、GIQLI、腹痛和腹胀评分值与术前值比较,各项观察指标均明显改善(P<0.001);术后第3、6个月腹痛程度评分(APIS)较术前改善不显著(P>0.05),术后第12、24个月营养风险筛查标准(NRS)较术前显著改善(P<0.05)。结论腹腔镜结肠次全切除逆蠕动盲直肠吻合手术治疗慢传输型便秘临床疗效显著,可以明显改善便秘病人的临床症状和营养状态,提高病人生活质量;术后随访显示手术后时间越长症状改善越明显,且创伤小、恢复快,并发症少,是一种安全、可靠和有效的手术方法。

Objective To observe the long-term outcomes of laparoscopic subtotal colectomy with antiperistaltic cecorectal anastomosis （LSCACRA） in treating slow transit constipation （STC）. Methods The clinical data of 40 patients with STC underwent LSCACRA between April 2007 and December 2009 in the 150th Central Hospital of PLA were analyzed retrospectively. The operation time, operation blood loss, first flatus time, hospital stay time and complications were analyzed. Preoperative and postoperative parameters of patients at 3rd, 6th, 12th, and 24th month were collected, including the Wexner constipation scale （WCS）, gastrointestinal quality of life index （GIQLI）. Results Laparoscopic operation was undertaken to all the patients without converting to open operation. There were two cases of incomplete ileus and two cases of pulmonary infection with Dindo〉 I . Comparing with the preoperative values, the values of WCS,GIQLI,AFIS and ABS at 3rd, 6th, 12th and 24th month after operation improved significantly （P〈0.001）. APIS didn＇t improve at 3rd and 6th month after operation comparing with the preoperative value （P〉0.05）, while the results at 12th and 24th improved significantly （P〈0.05）. Conclusion LSCACRA is a safe and effective operation method, which has a significant effect in the treatment of STC and notably relieves symptoms, nutritional status and quality of life of patients, presenting small wounds and faster recovery.