成人结肠冗长症的诊断与外科治疗82例报告

Intractable constipation caused by adult dolichocolon

目的总结成人结肠冗长症的诊断与外科治疗经验。方法对82例成人结肠冗长症极其主要合并症——顽固性便秘的临床资料进行回顾性分析。结果 82例中66例(80%)有顽固性便秘,28例(34%)有腹痛、腹胀,16例(19%)便秘与腹泻交替出现。82例中74例经 X 线钡剂灌肠透视,8例于急诊术中确诊。35例为结肠冗长症Ⅰ型;19例为Ⅱ型;28例为Ⅲ型(其中包括4个节段结肠冗长即全结肠冗长18例)。82例中行乙状结肠切除32例,右半结肠切除术3例,右半结肠及横结肠切除4例,横结肠左半及脾曲切除4例,降结肠及乙状结肠切除、将脾曲结肠向下游离与直肠上端吻合15例,横结肠、降结肠、乙状结肠切除、再将肝曲结肠向下游离与直肠上端吻合6例,全结肠切除、回肠末端与直肠上端吻合18例。82例术后无肠吻合口漏等严重并发症。术后随访3个月至4年,随访率为88%(72/82),疗效满意。结论根据顽固性便秘病史和 X 线钡剂灌肠透视可确诊成人结肠冗长症,外科手术是治疗成人结肠冗长致顽固性便秘的有效措施。

Objective To summarize the diagnosis and surgical treatment for intractable constipation caused by adult dolichocolon. Methods Clinical data of 82 adult dolichocolon cases suffering from intractable constipation were analyzed retrospectively. Results Of the 82 patients, intractable constipation were found in 66 patients （ 80% ）, abdominalgia,abdominal distension in 28 patients （ 34% ） and constipation alternatively with diarrhea in 16 patients （ 19% ）. Diagnosis was established in 74 patients by barium enema while 8 during the emergency operation. Dolichocolon was divided into 3 types as type Ⅰ in 35 cases, type Ⅱ in 19 and type Ⅲ in 28, in which there were 18 cases of total dolichocolon syndrome. Surgery performed including sigmoidectomy （32 patients ）, right hemicolectomy （3 patients ）, right hemicolon and transvers colon resection （4 patients）, left side of transvers colon and splenic flexure colon resection（4 patients）, descending colon and sigmoid colon resection （15 patients）, transvers, descending and sigmoid colon resection （6 patients）, pancolectomy with anastomosis of terminal ileum and upper rectum （18 patients）. There were no severe postoperative complications such as anastomotic leakage and the recovery was uneventful in all 82 patients. The curative effect was graded as well and up in all 72 cases followed up from 3 months to 4 years, with a follow-up rate of 88% （72/82）. Conclusion A history of intractable constipation and barium enema are the mainstay for the diagnosis of dolichocolon, and operation is the effective treatment for intractable constipation caused by adult dolichocolon.