结肠慢传输型便秘的诊治探讨(附30例分析)

Investigation on diagnosis and treatment of slow transit constipation

目的：探讨结肠慢传输型便秘的诊断及治疗方法，以提高疗效。方法：对部分顽固性便秘患者的临床症状、纤维结肠镜检查、结肠传输试验和排粪造影等的检查结果进行分析，确诊为结肠慢传输型患者３０ 例，并对其进行了手术治疗。其中全结肠切除、回肠与直肠吻合术９ 例，次全结肠切除、盲肠与直肠吻合术１９例，左半结肠切除２ 例。结果：结肠慢传输型便秘的病理见肠壁神经丛有变性、减少。回直肠吻合术后患者大便次数偏多，多数＞ ３ 次／ｄ，个别患者难以控制；行左半结肠切除术后的仍有排粪困难；而盲直肠吻合术效果较好，多数患者大便１～３ 次／ｄ。结论：结肠慢传输型便秘的患者行次全结肠切除，盲直肠吻合术效果较好。

Objective: To investigate the diagnosis and treament of slow transit constipation(STC). Methods: Thirty patients suffering from STC, diagnosed by clinic manifestation, colonscopy,colon transit test and defecography received surgery, including 9 cases of total colectomy with ileorectal anastomosis, 19 cases of subtotal colectomy with cecorectal anastomsis and 2 cases of left colectomy. Results: Followed up from 6 months to 7 years,the patients treated by ileorectal anastomosis usually defecated over 3 times per day with very few suffering of incontinence, While the patients received left colectomy still complained evacuation difficulties, patient subjected to cecorectal anastomosis had best postoperative outcome: average stool frequencies per day is 1～3 times in most of patients. Pathological findings suggested the nerve plexus in the intestinal wall of STC degenerated and decreased. Conclusion: The prognosis of STC treated by subtotal colectomy with cecorectal anastomosis is satisfactory.