结肠慢传输型便秘的外科治疗21例

Clinical analysis of surgical treatment of slow transit constipation

目的探讨结肠慢传输型便秘外科手术治疗的疗效。方法回顾性分析2005-2008年采用外科手术治疗21例结肠慢传输型便秘患者的资料,依术前结肠钡剂灌肠检查所了解升结肠张力情况及术中探查情况,其中10例患者采用结肠次全切除、盲直肠吻合术,11例患者采用全结肠切除、回直肠吻合术。结果两组均随访2～5年无复发,无手术死亡、吻合口瘘发生,疗效相同。结肠次全切除、盲直肠吻合术10例患者,短期腹泻(1月内)3例(30%),明显低于全结肠切除、回直肠吻合术(P<0.05),但随着时间的推移,加上口服药物的控制后明显改善;结肠次全切除、盲直肠吻合术后无顽固性腹泻(超过1年),全结肠切除、回直肠吻合术后1例顽固性腹泻于随访2年后明显改善。结论结肠次全切除、盲直肠吻合术,全结肠切除、回直肠吻合术两种术式治疗结肠慢传输型便秘均有满意疗效,但具体术式应依据术前检查及术中发现决定,而不能单独倾向于某一种手术。

Objective To investigate the slow-transit constipation efficacy of surgical treatment.Methods A retrospective analysis of 2005-2008 with 21 cases of surgical treatment of patients with slow transit constipation information,according to preoperative barium enema of colon to understand the situation of colon tension and intraoperative exploration,of which 10 patients with subtotal resection of the colon with blind rectal anastomosis,11 patients underwent total colectomy with ileorectal anastomosis.Results Both groups were followed up for 2 to 5 years without recurrence,no operative mortality,anastomotic leakage occurred,the same effect.Subtotal colon blind anastomosis in 10 cases of patients,short-term diarrhea（1 month）in 3 cases（30%）,significantly lower than total colectomy back anastomosis（P0.05）,but as time goes on,with oral drugs,after controlling for significant improvement in,subtotal colon blind rectal anastomosis without intractable（more than 1 year）,total colectomy rectal anastomosis in one cases back to intractable diarrhea was followed up to 2 years improved significantly.Conclusions The subtotal colon blind rectal anastomosis,total colectomy back anastomosis two kinds of surgical treatment of slow transit constipation have a satisfactory outcome,but the specific operation type should be based on preoperative examination and intraoperative discovery decisions,and not tend to a certain kind of surgery alone.