结肠次全切除逆蠕动盲肠直肠吻合术治疗慢传输型便秘的远期疗效

Long-term results of subtotal colectomy with antiperistaltic cecoproctostomy in chronic slow-transit constipation

目的评估结肠次全切除、逆蠕动盲肠直肠吻合术治疗特发性慢传输型便秘的远期疗效。方法对2003年1月至2004年2月14例单纯慢传输型便秘患者和2例慢传输型合并出口梗阻型便秘患者行结肠次全切除、逆蠕动盲肠直肠吻合术。术后随访患者的排便情况、并发症、生活质量及满意度。结果平均随访期为3年。所有患者术后无严重并发症及死亡。术后1个月每大平均排便4次(3～6次),半液体状大便。术后3年平均每天排便2次(1～3次),固体状大便。随访期间所有患者控便能力良好,无大便失禁发生。2例患者出现术后粘连性小肠梗阻。9例患者对手术效果满意,7例非常满意。所有患者生活质量得到明显改善。1例混合型便秘患者术后需间断性使用泻药。结论对部分慢传输型便秘患者行结肠次全切除后逆蠕动盲肠直肠吻合术效果理想。

Objective To assess the long-term results after subtotal colectomy with antiperistaltic ceooproctostomy in idiopathic chronic slow-transit constipation. Methods Between January 2003 and February 2004, 14 patients with chronic slow-transit constipation and 2 patients with mixed constipation underwent subtotal colectomy with antiperistaltic cecoproctostomy. The following information was collected during follow-up （mean 3 years） ： number of bowel movement, stool consistency, complications, quality of llfe and degree of satisfaction. Results There was no mortality or major postoperative complications. One month after the operation, bowel frequency was a mean of 4 dayly, with a semi-liquid stool consistency. After 3 years, bowel frequency was a mean of 2 dayly, with a semi-solid stool consistency. Although no patient used antidiarrheal medicine, laxatives continued to be used by one case with mixed chronic constipation. All patients reported a good or improved quality of life and satisfied with the results. Two patients developed adhesive ileus post operation. There was no diarrhea or incontinence ocurred during the follow-up. Condusions Subtotal colectomy with end-to-end antiperistahic cecoproctostomy for appropriately selected patients with slow-transit constipation results in consistent relief of constipation and satisfactory outcome.