腹腔镜与开放性全结肠切除术治疗结肠慢传输性便秘的比较

Comparison of the outcomes of laparoscopic surgery and open total colectomy for slow transit constipation

目的 评价经腹腔镜行全结肠切除术的安全性和可行性。方法 回顾性、对比分析 2 0 0 0年 10月至 2 0 0 4年 1月我院手术治疗的 2 3例结肠慢传输性便秘患者 ,分为传统开腹手术 (开放组 ,12例 )和经腹腔镜手术 (腹腔镜组 ,11例 )两组 ,比较两组病人的临床表现、结肠传输试验、排粪造影、手术时间、术中出血量、术后肛门排气时间、术后平均住院日和术后早期并发症。结果 2 3例均行结肠全切除术。开放组中附加直肠功能性悬吊和子宫前倾位固定 7例 ,附加直肠功能性悬吊、子宫前倾位固定和直肠前突修补 2例 ;腹腔镜组 11例全腹腔镜手术 3例 ,手助腹腔镜手术 8例 ,附加直肠功能性悬吊和子宫前倾位固定 2例。开放组手术时间明显短于腹腔镜组 ( 3 78h比 4 79h) ,两组的术中出血 ( 15 8 6ml比 10 7 1ml)、术后肛门排气时间 ( 3 71d比 2 86d)和术后平均住院天数 ( 10 14d比 14d)无明显差别 ,开腹组 1例发生切口裂开 ,腹腔镜组 1例发生左侧胸腔血性积液。术后 1月～ 16月随访 ,平均排便 2 45次 /d。结论 开腹或腹腔镜全结肠切除术均安全、有效 ,腹腔镜手术外观好 ,切口并发症少 。

Objective To evaluate the safety and efficacy of laparoscopic total colectomy for colonic slow transit constipation. Methods A total of 23 patients with colonic slow transit constipation undergoing surgical treatment from October 2000 to January 2004 were divided into laparoscopic surgery group ( n =11) and open surgery group ( n =12). The clinical manifestations, colonic transit test, defecographic results, operative time, intraoperative blood loss, postoperative time for recovery of the bowel function, average day of postoperative hospitalization, and the early postoperative complications were comparatively analyzed retrospectively. Results All the 23 patients were treated by total colectomy. In the open group, additional functional rectopexy and uteropexy were performed in 7 cases, and additional functional rectopexy, uteropexy, and rectocele repair in 2 cases. In the laparoscopic surgery group, laparoscopic surgery was performed in 3 cases and hand assisted laparoscopic surgery with additional functional rectopexy and additional uteropexy in 4 cases. The mean operative time for the open group was shorter than that for the laparoscopic surgery group (3.78 h vs 4.79 h). There was no difference in intraoperative blood loss (158.6 ml vs 107.1 ml), postoperative recovery of bowel function (3.71 d vs 2.86 d), and mean length of postoperative hospitalization (10 14 d vs 14 d). Incision dehiscence was found in 1 case in the open group, and bloody hydrops in the left thoracic cavity in 1 case in the laparoscopic surgery group during the postoperative period. A postoperative follow up ranging from 1 to 16 months showed that the average stool frequency was 2.45/d. Conclusion The laparoscopic surgery or open total colectomy is a safe and effective surgical method for colonic slow transit constipation. Laparoscopic surgery can result in a better cosmetic result, but the operative time is longer.