结肠次全切除与改良Duhamel联合术式治疗50例重度功能性便秘

Efficacy and safety of combined use of subtotalcolectomy and modified Duhamel procedure in the surgical treatment of severe functional constipation

目的探索临床上较为满意的治疗重度功能性便秘（src）的手术方式。方法分析2000年9月至2005年4月间50例SFC患者经结肠次全切除与改良Duhamel联合术式治疗的临床资料。结果50例曾予以严格的非手术治疗效果欠佳。经过结肠镜、结肠传输试验和排粪造影等检查，显示有明确的病理解剖和功能性异常部位后，均施行了结肠次全切除与改良Duhamel联合手术治疗。术后病理检查：27例（54％）结肠肌萎缩；29例（58％）结肠肌间丛细胞减少，神经纤维排列紊乱有缠结现象。全组术后随访（2．4±1．2）年，胃肠生活质量指标、便秘症状指标和出口功能指标均明显改善，44例（88％）患者对其排便感到满意，仅有9例（18％）诉轻度腹痛；3例（6％）有不同程度的腹泻，无大便失禁；2例（4％）有轻度便秘复发，应用膨胀性泻剂和促动力药后症状可缓解。结论结肠次全切除与改良Duhamel联合术式是治疗SFC较为合理、效果较好的手术方案。

Objective To explore the satisfactory surgical procedure for severe functional constipation （SFC）. Methods The data of 50 SFC patients, undergone subtotalcolectomy and modified Duhamel procedure from Sep. 2000 to Apr. 2005, were analyzed retrospectively. Gastrointestinal quality of life （GIQOL） of these patients were also evaluated. Results All the 50 patients failed to respond to conservative treatment and accepted subtotalcolectomy and modified Duhamel procedure after finding pathological changes by the examination of colonoscopy,colon transit time （CTr） and dynamic proctography （DPG）. Twenty-seven out of 50 cases （54%） showed colonic muscular atrophy and 29 out of 50 cases （58%） showed decreased ganglion cells in myenteric plexuses of colon. The mean fullow-up time after surgical treatment was （2.4±1.2） years. GIQOL and constipation index improved dramatically after operations. Fourty-four out of 50 patients （88%） were satisfied with their postoperative evacuation. Nine patients complained minor abdominal pain,3 patients diarrhea and 2 patients recurrence of constipation, who were healed by the use of bulk-forming laxatives and GImobility drugs. Conclusion The combination of modified Duhamel procedure and subtotalcolectomy is an effective surgical procedure for the treatment of SFC.