智能胶囊结肠压力测定对慢传输型便秘手术方式选择的临床意义

Colectomy based on pressure measurement of intelligent capsule to treat intractable transmission of chronic constipation

目的探讨智能胶囊结肠压力测定对慢传输便秘术式及疗效的评价作用。方法符合罗马III诊断标准、排除器质性便秘、内科治疗3年以上不缓解、有强力手术意愿的慢传输便秘患者31例,术前及术后半年同步口服智能胶囊结肠压力测定和结肠运输试验。术前检查结果决定手术方式:80%的不透X线颗粒在左半结肠停留超过72 h,或大于总时间的50%,结肠脾曲综合征,智能胶囊结肠压力测定左半结肠停留时间长、压力低幅传输波(low amplitude propagated contractions,LAPCs)及高幅传输波(high amplitude propagated contractions,HAPCs)少于右半结肠50%者行左半结肠切除;80%的不透X线颗粒在右半结肠停留超过72 h,或大于总时间的50%,LAPCs及HAPCs少于左半结肠的50%者行右半结肠切除;结肠运输试验时间>120 h,消化道压力测定为全结肠压力波明显减少,HPACs少于6次/d者行结肠次全切除;结肠运输时间>168小时,小肠通过时间>24 h,消化道压力测定为全结肠压力波明显减少,HAPCs<2次者行全结肠切除+回肠直肠切除;16例行传统剖腹手术,15例行腹腔镜手术。结果 31例均恢复出院,术后便秘改善明显改善,术后半年与术前比较智能胶囊的在体总时间、结肠通过时间及群发HAPCs、平均收缩幅度及生理相应比差异有统计学意义,但HAPCs及LAPCs数差异无统计学意义,结肠传输时间术后显著少于术前。腹腔镜手术组和传统手术组相比,术后肠粘连及肠梗阻发生率明显减少,3例全结肠切除术者术后早期腹泻明显。结论智能胶囊结肠压力波测定对手术方式选择有一定的指导意义,腹腔镜较传统手术创伤小、并发症少,有望成为慢传输便秘治疗的标准术式。

Objective To explore the colectomy based on pressure measurement of intelligent capsule to treat the intractable transmission of chronic constipation.Methods Thirty-one transmission of chronic constipation patients who measured up the Rome Standard III of constipation without organic constipation,ineffective medical therapy more than 3 years and with strong surgical desire were selected in the experiment.The intelligent capsule for measurement of colon pressure was taken orally synchronously with colon transportation test before surgery and half year after surgery.Way of surgery： left half colon excision were made if resident time in left half colon of 80% radiopaque particles was more than 72h or 50% of the total residence time or colon spleen song syndrome or longer resident time in left half colon detected by intelligent capsule or the amplitude of LAPCs and HAPCs was 50% less than those in right half colon.Right half colon excision were made if resident time in right half colon of 80% radiopaque particles was more than 72h or 50% of the total resident time or the amplitude of LAPCs and HAPCs was 50% less than those in left half colon.Subtotal colectomy were made if colon transportation test time was more than 120h or the total colon pressure wave decreased obviously detected by the digestive tract pressure measurement or the time of HPACs was less than 6 times/day.Pancolectomy plus bowel resection of rectal were made if colon transportation test time was more than 168h or duodenocecal transit time was more than 24h or the total colon pressure wave decreased obviously detected by the digestive tract pressure measurement or the time of HPACs was less than 2 times/day.Sixteen patients were treated with traditional celiotomy and 15 patients were treated with laparoscopy.Results The total resident time of intelligent capsule,colonic transit time,cluster wave of HAPCs,the average contact amplitude and the corresponding physiologic ratio of before surgery all differed statistically compared with those half year after surgery.There were no statistic difference between the number of HAPCs and LAPCs.The colonic transit time were statistically shortened after surgery.Compared with the traditional surgery group,the Laparoscopy group showed less incidence rate in postoperative intestinal adhesion and intestinal obstruction as well as better improvement of postoperative constipation.Three early postoperative patients underwent the pancolectomy operation had severe diarrhea.Conclusion The surgery treating resistant slow transmission constipation was effective.There were some instructive meaning of colon pressure wave measurement and colon transportation test for the selection of surgical ways.The pancolectomy operation was expected to become the standard surgery method for slow transmission constipation because it has smaller trauma and less postoperative complications compared with the traditional operation.