结肠旷置逆蠕动盲直肠吻合术治疗老年慢传输型便秘

Clinical studies on the results of chronic slow-transit constipation treated by colonic exclusion therapy and antiperistaltic cecoproctostomy

目的评估结肠旷置逆蠕动盲直肠吻合术并同时联合出口梗阻型便秘的手术,治疗老年顽固性慢传输型便秘合并出口梗阻型便秘的临床疗效。方法对2000-06～2004-12全军肛肠外科研究所住院手术治疗的36例70岁以上老年顽固性结肠慢传输型便秘合并出口梗阻型便秘的患者,行结肠旷置逆蠕动盲直肠吻合术并同时联合出口梗阻型便秘的手术治疗。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3年以上。所有患者术后无严重并发症及病死。术后1个月平均排便3～6次/d,液体状大便。术后1年以后平均排便2次/d,固体大便。随访期间所有患者排便控制能力良好,无大便失禁发生,排便满意度达89%。所有患者生活质量得到明显改善。结论对老年顽固性慢传输型便秘合并出口梗阻型便秘行结肠旷置逆蠕动盲直肠吻合术同时对出口梗阻型便秘行手术治疗,临床效果理想。

Objective To evaluate the effectiveness of colonic exclusion with antiperistaltic cecoproctostomy in the treatment of slow-transit constipation and outlet obstructive constipation. Method From June 2000 to December 2004,36 elderly patients with chronic slow-transit constipation and mixed constipation underwent colonic exclusion therapy wih antiperistahic cecoproctostomy. The following information was collected during follow-up （mean 3 years）： number of bowel movement, stool consistency, complications, quality of life and degree of satisfaction. Result There was no mortality or major postoperative complication. One month after the operation, defecation frequency was a mean of 4 daily, with a semi-liquid stool consistency. After 3 years, defecation frequency was a mean of 2 daily, with a semi-solid stool consistency. All the patients had a good or improved quality of life and satistied with the results.There was no diarrhea or incontinence occurred during the follow-up. Conclusion For elderly patients with slow-transit constipation and outlet obstructive constipation, the efficacy of colonic exclusion with antiperistahic cecoproctostomy accompanied with other types of operation for outlet obstructive constipation is satisfactory.