结肠次全切除逆蠕动盲直吻合术治疗特发性慢传输便秘

Sub-total Colectomy with Anti-peristaltic Cecoproctostomy for the Treatment of Idiopathic Chronic Slow-Transit Constipation

目的 :评估结肠次全切除伴逆蠕动盲直吻合术治疗特发性慢传输型便秘的疗效。方法 :特发性慢传输型便秘患者 12例 ,慢传输型合并出口梗阻型便秘患者 1例 ,行结肠次全切除伴逆蠕动盲直吻合术。所有患者术前排便均为泻药依赖性 ,平均 9d排大便 1次。术后随访记录患者排便情况、并发症、生活质量。结果 :所有患者术后无严重并发症及死亡。术后 1个月每天平均大便次数为 2 .4次 (1～ 5次 ) ,半液体状大便。术后 8个月平均每天大便次数 1.6次 (0 .7～ 3.5次 ) ,半固体状大便。术后所有患者均不需用止泻药 ,1例混合型便秘患者仍用泻药外其余患者均未用泻药。 13例患者 (10 0 % )术后生活质量得到明显改善。术后 1例患者出现粘连性小肠梗阻 ,其余患者未出现腹泻、腹痛、腹部不适等并发症。结论 :对部分慢传输便秘患者选择性行结肠次全切除后逆蠕动盲直端端吻合术近期效果理想 ,但长期疗效需进一步研究。

Objective:To assess the functional results after subtotal colectomy with antiperistaltic cecoproctostomy for the treatment of idiopathic chronic slow-transit constipation.Methods:12 patients with idiopathic chronic slow-transit constipation and 1 patient with mixed chronic constipation, underwent subtotal colectomy with antiperistaltic cecoproctostomy. Before operation,all patients were laxative-dependant, with a mean bowel frequency of 9 days. The following informations were collected during the period of follow-up: number of bowel movements; stool consistency; complications; quality of life.Results:There was no mortality or major postoperative morbidity. One month after the operation, bowel frequency was a mean of 2.4(range, 1~5) per day, with a semiliquid stool consistency. After 8 months, bowel frequency was a mean of 1.6(range, 0.7~3.5) per day, with a semisolid stool consistency. Although no patients used antidiarrheal medicine, laxatives continued to be used by one patient with mixed chronic constipation. All patients (100%) reported a good or improved quality of life. A patient had adhensive ileus postoperatively. At a mean 8-month follow-up (range, 3~12), all patients showed no diarrhea or incontinence,and were compeletely relieved of previous symptoms and abdominal discomfort.Conclusion:Subtotal colectomy with end-to-end antiperistaltic cecoproctostomy seems to be a safe and effective procedure for selected patients with idiopathic chronic slow-transit constipation. However, long-term symptomatic and functional outcome need further study.