结肠次全切除术联合改良Duhamel术与单纯结肠次全切除术治疗重度功能性便秘的对比分析

Comparative analysis between subtotal colectomy combined with modified Duhamel procedure and simple subtotal coleetomy for severe functional constipation

目的对比分析结肠次全切除术联合改良Duhamel术与单纯结肠次全切除术治疗重度功能性便秘（SFC）的疗效及并发症。方法2006年1月至2010年6月收治40例经过严格内科治疗后效果欠佳的SFC患者，按随机数字表法分为对照组和联合组，每组20例，分别施行单纯结肠次全切除术和结肠次全切除术联合改良Duhamel术治疗。随访6个月至2年，对比两组术后近期疗效及随访结果。结果两组手术均获成功，术后肛门排气时间、住院时间、术后早期并发症和大便失禁等比较差异无统计学意义（P〉0．05）。联合组GIQOL评分[（110．5±5．0）分]、便秘症状改善度[（79．0±6．5）％]、便秘复发率[10．0％（2／20）]、排便频率满意率[85．0％（17／20）]、生活质量满意率[90．0％（18／20）]明显优于对照组[分别为（90．5±3．5）分、（60．5±2．8）％、35．0％（7／20）、15．0％（3／20）、20．0％（4／20）]（P〈0．05）。结论结肠次全切除术联合改良Duhamel术治疗SFC较单纯结肠次全切除术对于胃肠功能改善更明显，是较为合理、疗效较好的手术方案。

Objective To compare postoperative outcomes and complications between subtotal colectomy combined with modified Duhamel procedure and simple subtotal colectomy for severe functional constipation （SFC）. Methods Between January 2006 and June 2010,40 SFC patients after strict butinefficient nonoperative treatments were randomized by number table method to control group （20 cases, receiving simple subtotal eolectomy） and combined group （20 cases,receiving subtotal colectomy and modified Duhamel procedure）. The selection criteria were normal colonoscopy,and abnormal dynamic proctography （DPG）. The functional outcomes after surgery were assessed from 6 months to 2 years period. Results The preoperative clinical manifestations of the two groups were similar. No statistically significant difference was observed between the two groups for time for recovery- of the bowel function, length of postoperative hospitalization, and the early postoperative complications （P 〉 0.05 ）. Functional outcomes of combined group with GIQOL score [ （110.5 ± 5.0） scores],relieving of costive gastrointestinal symptoms [ （79.0 ± 6.5）% ], recurrent constipation rate [ 10.0% （2/20）3, satisfaction rate of defecation frequency [ 85.0% （ 17/20 ） ], satisfaction rate of quality of life [ 90.0% （ 18/20 ） ] were significandy better than those of control group[ （90.5 ± 3.5） scores, （60.5 ± 2.8）% ,35.0% （7/20）, 15.0%（3/20）,20.0%（4/20）]（P〈 0.05）. Conclusion Combined application of subtotal colectomy and modified Duhamel procedure for SFC has better outcomes.