腹腔镜结肠次全切除逆蠕动盲肠直肠吻合术治疗结肠慢传输型便秘

Laparoscopy assisted subtotal colectomy with antiperistalsis cecorectal anastomosis for slow transit constipation

目的探讨腹腔镜结肠次全切除、逆蠕动盲肠直肠吻合术在治疗结肠慢传输型便秘中的临床应用价值。方法2007年9月至2010年10月对收治的31例结肠慢传输型便秘患者进行腹腔镜结肠次全切除、逆蠕动盲肠直肠吻合术，术后3个月和12个月进行随访，以评定手术效果。结果全组患者手术均成功，无中转开腹手术，手术时间平均260min（180—310min），术中出血量平均60ml（30—120m1），术后平均住院日8d（6—11d），无吻合口瘘、粘连性肠梗阻、切口及腹腔内感染等手术近期并发症。术后3个月随访，便秘症状明显缓解23例，轻度腹泻5例，腹泻2例，症状轻度复发1例。术后12个月随访，便秘症状明显缓解25例，轻度腹泻5例，症状轻度复发1例。结论腹腔镜结肠次全切除、逆蠕动盲肠直肠吻合术治疗结肠慢传输型便秘，具有创伤小、术后恢复快的优势，临床安全有效，值得临床运用。

Objective To investigate the clinical application value of laparoscopy-assisted subtotal colectomy with antiperistalsis cecorectal anastomosis for slow transit constipation （STC）. Methods From September 2007 to October 2010, a total of 31 patients with STC underwent laparoscopic-assisted subtotal colectomy with antiperistalsis cecorectal anastomosis. A follow-up survey was completed at 3 and 12 months af- ter the operation. Results No death or conversions to open operation occurred. The mean operation time, mean intraoperative blood loss and mean post-operative hospitalization were 260 min （180-310 min）, 60 ml （ 30-I 20 ml） and 8d （6-11 d）, respectively. No postoperative infection, anastomotic stoma, adhesive intes- tinal obstruction or other perioperative complications occurred. In 3-month follow-up, constipation was significantly alleviated in 23 patients, mild diarrhea occurred in 5, diarrhea in 2 and mild recurrence in 1. Consti- pation was significantly alleviated in 25 patients, mild diarrhea occurred in 5 and mild recurrence in 1 at 12- month follow-up. Conclusion Laparoscopy-assisted subtotal colectomy with antiperistalsis cecorectal anas- tomosis is safe, effective and less invasive for STC.