结肠型便秘合并出口梗阻型便秘的治疗

Treatment of Colonic Constipation Complicated with Outlet Obstructive Constipation

为探讨结肠型便秘合并出口梗阻型便秘的诊断和治疗，对348例顽固性便秘根据共临床表现、结直肠及盆底动力学等检查的结果进行分析诊断。对结肠冗长症采用结肠全切除及次全切除术治疗，其中327例伴有出口梗阻型便秘者于结肠切除术同期或前期采用相应的手术治疗。结果显示，病理检查示结肠壁内神经丛均有变性。94％（327／348）伴有出口梗阻。术后随访1～5年，手术有效率为93．8％。结果表明，结肠型便秘的治疗应根据结肠造影及结肠传输试验确定的病变程度、分布范围及是否合并出口梗阻选择适合的手术方案。

The 348 intractable constipation patients were differentiately diagnosed on the basis of clinical symptoms,colorectal dynamic examination and pelvic floor dynamic examination so as to probe into the therapy for colonic complicated with outlet obstructive constipation. The patients with redundant colon underwent total colon resection or subtotal resection, and other appropriate surgical operations were done at the corresponding period or at the earlier stage for 327 patients（327/348） who had complicated outlet obstructive constipation. Pathological examination showed that there existed degeneration of the nerve plexus in the colonic wall and outlet obstruction was found in 94.0% of the patients（327/348）. Follow up of 1-5 years showed that the improvement rate of such treatment was 93.8%. It is concluded that appropriate treatment of constipation of the colon type should be based on colon defecography and colon transit test to decide the disease severity,distribution and the complicated outlet obstruction.