慢传输型便秘合并成人巨结肠32例临床诊治

Diagnosis and treatment of slow transit constipation complicated with adult megacolon

目的总结慢传输型便秘合并成人巨结肠的诊断和治疗经验。方法回顾性分析2007年10月至2011年6月收治的32例慢传输型便秘合并成人巨结肠患者的临床资料。结果32例患者中男15例，女17例，年龄18～56岁，均符合罗马Ⅲ便秘诊断标准。结肠传输试验提示结肠传输缓慢；钡灌肠及排粪造影提示肠管狭窄段位于横结肠3例，降结肠4例．直肠20例，横结肠或降结肠与直肠同时存在狭窄段5例；肛门直肠测压显示23例直肠肛门抑制反射消失，另9例未见异常。手术治疗行巨结肠切除、结肠部分切除、结肠结肠侧侧吻合术7例；巨结肠切除、结肠次全切除、结肠直肠下端改良Duhamel吻合术16例：结肠全切除、回肠储袋J-Poueh与直肠下端改良Duhamel吻合术9例。术后无并发症发生，随访3～47个月，18例患者排粪功能优，9例良，5例～般。结论慢传输型便秘临床诊治中应警惕合并成人巨结肠：详细询问病史和对辅助检查的综合分析是减少漏诊和误诊的关键。手术切除范围应包括病变的巨结肠和有慢传输的结肠．并按巨结肠根治术方式进行吻合。

Objective To summarize the experience in the management of slow transit constipation complicated with adult megacolon. Methods The clinical data of 32 above patients admitted between October 2007 and June 2011 were retrospectively studied. Results Thirty-two patients were diagnosed as slow transit constipation according to the Roman Ⅲ criteria. There were 15 males and 17 females aging from 18 to 56 years old. Sitz marker study showed prolonged colon transit time. Barium enema and defecography suggested bowel stricture locating in the transverse colon （n=3）, descending colon （n=4）, rectum （n =20）, and concurrent transverse colon or descending colon and rectum （n=5）. Anal manometry showed that anorectal inhibitory reflex was absent in 23 patients, while the other 9 patients were normal. Procedures performed included segmental colectomy and side-to-side anastomosis （n=l）, subtotal colectomy and modified Duhamel anastomosis （n=16）, total colectomy and ileal J-pouch Duhamel anastomosis（n=9）. There were no postoperative complications. During the follow-up ranging from 3 to 47 months, defacatory function was excellent in 18, good in 9, and moderate in 5 patients. Conclusions Adult megacolon should be considered differential diagnosis of slow transit constipation. Detailed history taking and thorough evaluation of testing is the key to obviate misdiagnosis. Extent of resection should include the diseased dilated colon and slow transit colon.