结肠慢传输型便秘65例治疗体会

Treatment of colon slow transit constipation： Report of 65 cases

目的探讨合理的结肠慢传输型便秘（slowtransitconstipation，STC）手术方式的选择。方法回顾性分析了我院及中南医院结直肠肛门外科1999年至2010年65例接受手术STC患者的治疗资料。结肠次全切除45例（逆蠕动盲直吻合术36例、升直吻合术6例、回肠乙状结肠侧侧吻合术3例）；结肠全切除16例（回直吻合术15例、部分回肠切除术1例）；结肠大部分旷置4例（逆蠕动盲直吻合术3例、回直吻合术1例）。结果62例患者便秘症状在术后得到不同程度地改善（有12例患者偶尔或间断很少次数地使用泻药或灌肠来改善间断出现的排便不畅），仅有3例患者手术后便秘状无改善或术后1年再次复发。结论结肠STC手术方式选择需要结合术前便秘专科检查、年龄、术前并存疾病、术中情况的综合考虑。

Objective To explore the proper surgical approach for slow transit constipation （STC）. Methods The clinical data of 65 patients with STC that underwent surgical treatment from 1999 to 2010 in our hospital and Zhongnan hospital were retrospectively analyzed. Forty-five patients were trea- ted with subtotal colectomy, in which the cases of antiperistaltic cecoproctostomy, ascending colorectal an- astomosis and side-to-side ileosigmoidostomy were 36,6 and 3 respectively; I6 patients were treated with total colectomy, including 15 cases of ileoproctostomy and 1 case of partial resection of ileum; 4 patients were treated with subtotal colon exclusion, including 3 cases of antiperistaltic cecoproctostomy and 1 case of ileoproctostomy. Results Sixty-two patients had symptomatic improvement （ and 12 patients sporadically need use of laxatives or enemas to improve the symptoms of obstructed defecation）. Only 3 patients had no symptomatic improvement after surgery or relapsed after 1 year. Conclusion Surgical approach for STC needs to be comprehensively chosen based on preoperative professional examination, age, synchronous dis- ease, and intraoperative conditions.