改良Duhamel术联合结肠次全切除术与单纯结肠次全切除术治疗重度功能性便秘的疗效比较

Comparison on the Therapeutic Effects of the Combination of Improved Duhamel Procedure and Subtotal Co- lectomy with alone Subtotal Colectomy for Treating Severe Functional Constipation

为比较改良Duhamel术联合结肠次全切除术与单纯结肠次全切除术治疗重度功能性便秘（SFC）的临床疗效，选择浙江省荣军医院和嘉兴市第二医院2008年1月至2012年6月收治的58例经内科严格治疗疗效欠佳的SFC患者，按随机抽样法分为对照组和观察组，各29例，对照组接受单纯结肠次全切除术治疗，观察组接受改良Duhamel术联合结肠次全切除术治疗。随访3～40个月，比较两组术后近期疗效及随访情况。结果显示，两组患者手术均获成功，无死亡病例，在术后肛门排气时间、住院时间、排便次数、术后早期并发症方面比较差异均无统计学意义，P〉0．05；但观察组便秘症状改善度、胃肠生活质量（GIQOL）评分、排便频次满意率、生活质量满意率和便秘复发率等指标均明显优于对照组，P〈0．05。结果表明，与单纯结肠次全切除术相比，改良Duhamel术联合结肠次全切除术治疗SFC，患者术后胃肠功能改善更明显，满意度更高，是一种疗效更好、更为合理的手术方案。

In order to compare the clinical effects of the combination of improved Duhamel procedure and subtotal coleetomy with alone subtotal colectomy in the treating severe functional constipation（SFC）, au- thors selected 58 SFC patients who admitted in zhejiang provincial hospital for disabled soldiers and the second hospital of jiaxing city failed to strict internal medicine treatment, and divided them into observation group and control group randomly, 29 cases for each;control group only received subtotal colectomy,obser- vation group received the combination therapy, the a follow-up lasted 3-40 months;the short-term effect af- ter operation and follow-up outcomes were compared with each other. As results,in both groups operation all completed successfully,there was no death cases;after operation in flatus time, hospitalization duration, defecation frequency and early postoperative complication there was no statistical differences between both groups（ P 〉0. 05） ; but, in improvement degree of constipation, GIQOL （gastrointestinal quality of life ） score rating, satisfactory rate for defecation frequency, satisfactory rate for the quality of life, and recur- rence rate of constipation, etc observation group was all superior to control group（ P〈0.05）. Results show that compared with alone subtotal colectomy the combination therapy for treating SFC can make gas- trointestinal function of patients improved more significantly, satisfactory degree of patients being more higher,thus it is a procedure having more better curative effects and of more rationality.