重视顽固性便秘规范化诊治

Pay attention to the standardized diagnosis and treatment of refractory constipation

顽固性便秘得不到规范化诊治是影响其远期疗效的主要原因。其治疗应该建立在全面、系统检查和评估的基础上,明确致病因素,对病人进行分型、分级,从而为选择治疗方案提供依据。顽固性便秘应首选非手术治疗,采用饮食指导、心理治疗、生物反馈治疗、优化的药物阶梯治疗以及生物代谢调理等个体化综合治疗模式,替代目前以药物为主的经验性治疗模式。外科手术是非手术治疗失败后的最后手段。绝大多数顽固性便秘病人为混合型便秘,而单独为慢传输型便秘或单独为出口梗阻型便秘而设计的手术疗效均不理想。金陵术(即施行结肠次全切除以解除病人慢传输的病因,同时又行升结肠直肠后壁侧侧吻合,纠正盆底解剖和功能紊乱,解除出口梗阻病因)可同时纠正结肠慢传输合并出口梗阻的混合型便秘病理生理紊乱,其近、远期疗效均满意。随着便秘手术方式的进一步合理化以及腔镜技术的发展,微创外科在便秘治疗中将扮演重要角色。

The primary factors impacting outcomes of patients with refractory constipation include the non-standardization of diagnosis, operative and non-operative therapy. The treatment of refractory constipation should be based on systematic examines and evaluation. After grading and typing the patients according to the cause of the disease, we could then determine the therapeutic regimen and principle. Non-operative therapy is the first choice for refractory constipation, we should use an individual systematic therapy which contains dietary therapy, psychological treatment, biofeedback therapy, optimal stepped medication and regulation of biological metabolism instead of the traditional medicine mainly therapy. Operative therapy is the last choice after the non-operative therapy has failed, and then most of the patients have developed to refractory mixed constipation. The surgery procedure specifically designed for isolated slow-transit constipation or obstructive defecation cannot achieve ideal effect. To treat severe refractory constipation in patients with combined slow-transit constipation and obstructive defecation, a new surgical procedure （named ＂Jinling procedure＂ in our hospital） was developed. The Jinling procedure combines subtotal colectomy and side-to-side cecorectal anastomosis, aiming to solve the coexistence of obstructive defecation and slow-transit constipation in one operation. Initial and long term results have been promising. With the development of laparoscopy and the further rationalization of surgical treatment for constipation, the minimally invasive surgery would play an important roie in treating constipation.