经腹腔镜和开腹结肠次全切除术治疗结肠慢传输性便秘的比较

Comparisons of Laparoscopic Surgery and Open Subtotal Colectomy for Slow Transit Constipation

目的:评价经腹腔镜结肠次全切除术的安全性和可行性。方法:回顾对比分析2006年8月至2009年10月我院手术治疗39例结肠慢传输性便秘患者,分经腹腔镜手术(腹腔镜组)19例和开腹手术(开腹组)20例两组,比较两组病人手术操作用时间、术中出血量、术后肛门恢复排气时间、术后平均住院时间和术后并发症。结果:39例均行结肠次全切除术,腹腔镜组中全腹腔镜手术9例,手助腹腔镜手术10例,附加直肠子宫功能性悬吊固定5例,开腹组中附加直肠子宫功能性悬吊固定、盆底抬高和盆底修复6例;腹腔镜组手术用时间明显多于开腹组(4.45h和3.46h),术中出血(101.3ml和163.7ml)、术后肛门恢复排气时间(3.52d和3.25d)和术后平均住院时间(14.8d和13.7d)两组无明显差异;术后随访3-16个月,平均排便2.37次/d,腹腔镜组2例间发轻度腹痛,半年后缓解;开腹组1例发生切口脂肪液化,2例并发不全性肠梗阻,保守治疗后缓解,1例便秘复发,药物辅助排便。9例(腹腔镜组5例,开腹组4例)术后大便次数多于5次/d,口服易蒙停类药物控制便频后停药。结论:开腹或腹腔镜结肠次全切除术均安全、有效,腹腔镜手术外观好,术后并发症少,但手术时间长。

Objective： To assess the safety and feasibility of laparoscopic subtotal colectomy for colonic slow transit constipation. Methods： From August 2006 to October 2009, 39 patients with slow transit constipation in our hospital treated by surgery were divided into laparoscopic surgery group （n=19） and open surgery group （n=20）. Clinical data were comparatively analyzed retrospectively between the two groups including operative times, blood loss, time to return of flatus, length of postoperative hospital stay, and complications. Results： All of 39 patients were treated by subtotal colectomy. In laparoscopic surgery group, laparoscopic surgery was performed in 9 cases, hand-assisted laparoscopic surgery was performed in 10 cases, and additional functional uterus rectumsuspension was fixed in 5 cases. In open surgery group, additional functional uterus rectumsuspension was performed in 20 cases, pelvic floor elevated and pelvic floor repaired in 6 cases. The mean operative time for the laparoscopic group was longer than the open group （4.45 h vs 3.46 h, P0.05）. There was no difference in blood loss （101.3 ml vs 163.7 ml）, time to return of flatus （3.52 d vs 3.25 d）, and length of postoperative hospital stay （14.8 d and 13.7 d）. All patients were followed up for 3 to 16 months, the average stool frequence was 2.37 per day. In laparoscopic surgery group, 2 cases with mild abdominal pain were relieved after six months. In open group, 1 case had fat liquefaction, 2 cases with incomplete intestinal obstruction relieved after conservative treatment, and 1 case with relapsed constipation was treated by drug. Nine cases with over 5 times stool every day （5 cases in laparscopic surgery group, 4 cases in open group） were also treated by drug. Conclusion： Both laparoscopic surgery and open subtotal colectomy are safe and effective, but laparoscopic surgery remains mini scars, however the operation time is longer.