逆蠕动盲肠直肠吻合术在结直肠外科重建中的应用

Use of antiperistaltic cecoproctostomy in colorectal reconstruction

目的探讨逆蠕动盲直吻合术在结直肠外科重建中的安全性和疗效。方法回顾性分析56例行逆蠕动盲直吻合术患者的临床资料。结果56例患者中结肠慢传输型便秘或混合型便秘患者44例：左半结肠多原发癌或结肠癌合并结肠多发息肉5例：左半结肠癌合并急性肠梗阻4例；成人巨结肠3例。手术行结肠次全切除、逆蠕动盲肠直肠吻合术53例；结肠大部分旷置、逆蠕动盲直吻合术3例。术后出现伤口感染5例．淋巴漏3例。炎性肠梗阻1例．无吻合口瘘和围手术期死亡病例。经过1个月至7年的随访．3例患者出现小肠梗阻，1例腹壁切口疝，1例轻度盲肠扩张。术后4年．中位排粪次数为2．5次／d．平均wexner肛门失禁评分为4．2±1．1。结论逆蠕动盲直吻合术用于结直肠的重建安全可行．疗效满意。

Objective To explore the feasibility and functional outcome of antiperistaltic cecoproctostomy in colorectal reconstruction. Methods Fifty-six patients who underwent antiperistaltie eecoproctostomy were retrospectively studied. Indications for antiperistaltic cecoproetostomy included slow transit constipation（n=44）, synchronous colon cancer or colonic polyps（n=5）, acute obstructing left colon carcinoma（n=4）, and adult megaeolon（n=3）. Results Short-term postoperative complications included wound infections （n=5）, 3 lymphatic leakages （n=3）, and inflammatory small bowel obstruction （n=1）. One month after antiperistaltic cecoproctostomy, the median frequency of daily bowel movement was 4.0（range, 2-6）. After a median follow-up of 4 years（range, 1 month to 7 years）, the median daily bowel frequency was 2.5（range, 0.5-4.0）. Five patients suffered from long-term postoperative complications including small bowel obstruction（n=3）, incision hernia（n=1）, and mild cecal dilatation （n=1）. The mean Wexner incontinence score was 4.2±1.1. Conclusion Antiperistaltic ceeoproctostomy is safe and effective for colorectal reconstruction.