不同术式治疗结肠慢传输型便秘的疗效比较

Surgical therapy for colonic slow transit constipation: an analysis of 89 cases

目的对比观察结肠慢传输型便秘的4种外科术式治疗效果。方法回顾性总结 1990年10月至2002年11月施行的89例94例次的手术治疗资料,数据处理采用t检验。结果行结肠全切除术6例,术后短期内腹泻6例(100％),难治性腹泻1例(16．7％),无便秘复发;结肠次全切除术73例,短期内腹泻19例(26％),明显低于结肠全切除术(t=1．90,P<0．05),无难治性腹泻, 复发1例,出现吻合处梗阻1例,切口感染2例;盲直肠端侧吻合术12例,疗效与结肠次全切除术相同,但手术时间和失血量均明显少于结肠次全切除术(t=2．849和10.455,P<0．01);结肠部分切除术3例,均于短期内复发。本组病例无手术死亡、吻合口瘘发生。结论结肠次全切除、结肠全切除和盲直肠端侧吻合术对结肠慢传输型便秘均有满意的疗效,应根据患者的具体病情选择术式,但结肠全切除术后腹泻发生率高,结肠部分切除术疗效不肯定。

Objective To evaluate the result of different surgical modality on colonic slow transit constipation. Methods We retrospectively reviewed clinical data of 89 patients with intractable colonic slow transit constipation undergoing surgical treatment for 94 times from Oct 1990 to Nov 2002. Results Six patients undergoing total colectomy suffered transit diarrhea and one with intractable diarrhea （ 16. 7% ） but without constipation recurrence. Nineteen out of 73 cases undergoing subtotal colectomy suffered from transit diarrhea （26%）, and one case suffered from constipation recurrence. Cecorectostomy was performed in 12 cases with a comparable result as subtotal colectomy. Constipation recurred in all 3 cases receiving partial colectomy. There was no operative mortality nor anastomotic fistula occurrenced. Conclusion Total colectomy, subtotal colectomy and cecorectostomy are satisfactory modality for the treatment of STC. Patients with total colectomy suffered from high rate of diarrhea.