腹腔镜下全结肠切除术治疗顽固性结肠慢传输型便秘的临床疗效研究

Clinical study on laparoscopie total colectomy treatment for refractory colonic slow - transit consti-pation

目的评价腹腔镜下全结肠切除术治疗顽固性结肠慢传输型便秘（CSTC）的安全性、有效性与可行性。方法2002年6月至2010年12月对53例顽固性CSTC患者采用全结肠切除术，其中腹腔镜组24例，开腹组29例。结果腹腔镜组与开腹组患者在切口长度[（5．27±0．33）CITI比（15．83±0．68）cm]、术后止痛剂使用次数[（2．04．±0．46）比（6．28±0．65）]、术后肠道功能恢复时间[（2．25±0．68）h比（4．41±0．95）h]、术后住院及出院期间粘连性肠梗阻并发率（4．17％比24．14％）及住院时间[（9．50±0．98）d比（14．76±1．67）d]方面差异均有统计学意义（P〈0．05）。结论腹腔镜下全结肠切除术治疗CSTC是一种更加安全有效、创伤小、瘢痕小、恢复快、并发症少的手术方式，值得临床推广。

Objective To evaluate the safety,efficacy and feasibility of laparoscopie total colectomy for refractory colonic slow - transit constipation （CSTC）. Methods Fifty - three patients with refractory CSTC receiving total colectomy from 2002 to 2010 in the Second Affiliated Hospital of Harbin Medical University were retrospectively analyzed, and were divided into laparoseopic group （ 24 cases） and open group（29 eases）. The clinical curative effects of the two groups were statistically analyzed and compared. Results All the 53 cases received total colectomy. There were no significant differences in general conditions, operative duration, blood loss, postoperative stool frequency or improvement rate of symptoms between the two groups. But there were significant differences in incision length （5.27 ± 0.33 vs. 15.83 ± 0.68; P = 0. 024 ） , postoperative analgesic frequency（ 2.04 ±0.46 vs. 6.28 ±0.65 ; P = 0. 012 ）, postoperative recovery of bowel function （2.25 ± 0. 68 vs. 4.41 ± 0. 95 ; P = 0.029）, postoperative incidence of adhesion ileus during hospitalization and discharge（4. 17% vs. 24.14% ; P = 0. 043） and postoperative hospital stay（9.50 ±0.98 vs. 14.76 ±1.67; P=0.039） between the two groups（P 〈0.05）. Conclusion Laparoscopic total eolectomy for CSTC is a safer and more effective operation method with less trauma, better cosmetic results,faster recovery and fewer comnlications. It is worthv of wider clinical annlication.