行金陵术治疗多次手术治疗无效顽固性混合型便秘135例分析

Clinical Outcome of Jinling Procedure for Refractory Constipation with Previous Failures of Surgical Interventions

目的探讨应用结肠次全切除联合升结肠直肠侧侧吻合术(金陵术)治疗多次手术治疗仍无效的顽固性混合型便秘的有效性。方法回顾性分析2000年1月至2010年6月在南京军区南京总医院行金陵术治疗的顽固性便秘病人的临床资料,将既往已接受外科手术治疗仍无效的病人纳入研究。结果共407例确诊为顽固性混合型便秘的病人接受金陵术,其中既往有手术史但仍无效的共计135例(33.2%)。既往曾行盆底手术[吻合器痔上黏膜环切术(PPH)、吻合器经肛门直肠切除术(STARR)、经阴道直肠前壁修补术、耻骨直肠肌部分切除术、经阴道吊带盆底重建等]55例(40.7%),行经腹手术(乙状结肠切除+降结肠直肠吻合、部分结肠切除吻合术、结肠造口、经腹直肠悬吊术等)80例(59.3%);既往接受盆底和经腹手术次数分别为平均2.1次和1.1次手术。我院再次手术治疗时,64.4%(87/135)接受开腹的金陵术,35.6%(48/135)接受腹腔镜辅助金陵术。全组病人术后1、6个月和1年来院随访,满意率分别达到88.9%、92.7%和95.0%。结论金陵术可以同时纠正导致混合型便秘的结肠慢运输和出口梗阻的两种病理生理紊乱,可作为多次手术失败后的顽固性混合型便秘外科治疗的有效选择之一。

Objective This study aims to exam the efficiency and safety of Jinling procedure for refractory mixed constipation after previous several surgical failures. Methods The patients of refractory mixed constipation receiving Jinling procedure between 2000 Jan and 2010 Jun after previous several surgical failures were included. Results 407 refractory mixed constipation patients received Jinling procedure during the study period. This study included 135 refractory mixed constipation patients receiving Jinling procedure with previous several surgical failures. Of all the 135 patients, 40.7% previously received pelvic surgeries （average 2.1） and 59.3% received open abdominal surgeries （average 1.1）. The satisfactory rate at the 1-, 6- and 12-month follow-up was 88.9%, 92.7% and 95.0%, respectively. Conclusions Jinling procedure is a surgical innovation for refractory mixed constipation, which can correct the coexistence of slow transition and obstructive outlet syndrome. Jinling procedure is regarded as one of the effective treatments for refractory mixed constipation with previous several surgical failures.