金陵术与全结肠切除回直肠侧侧吻合术治疗混合型顽固性便秘前瞻性对照研究

Clinical outcome between Jinling procedure and total colectomy with ileorectal side-to-side anastomosis for refractory mixed constipation:A prospective controlled trial

目的比较金陵术与全结肠切除、回直肠侧侧吻合术治疗混合型顽固性便秘的有效性和安全性。方法自2009年2月至2010年12月,南京军区南京总医院收治156例混合型顽固性便秘病人,根据病变范围分为金陵术组(A组)和全结肠切除组(B组),进行前瞻性对照研究。A组采用腹腔镜辅助金陵术,B组采用腹腔镜辅助全结肠切除、回直肠侧侧吻合术。结果观察指标包括手术时间、术后排气时间、术后住院日、术后需使用止泻药物强度、Wexner便秘评分、胃肠生活质量评分(GIQLI)、术后排便频次、腹泻发生率、腹泻严重度、手术满意率、手术满意度、便秘复发率、并发症发生率、血清电解质水平、并发症发生率。两组病人术后GIQLI及Wexner便秘评分较术前均有显著性改善(P<0.05);A组术后排便频次、腹泻发生率、手术满意度、GIQLI、Wexner便秘评分、恢复进度均优于B组(P<0.05);两组手术并发症发生率差异无统计学意义(P>0.05),B组粘连性肠梗阻发生率高于A组,但差异无统计学意义,粘连性梗阻需手术治疗率显著高于A组。结论外科治疗混合型便秘时,金陵术优于全结肠切除联合回肠直肠侧侧吻合,在解决病人便秘症状的基础上,病人可获得更好的生活质量和较高的满意度。

Objective To compare the morbidity and efficacy between Jinling procedure and total colectomy with ileorectal side-to-side anastomosis in the treatment of refractory mixed constipation. Methods A total of 156 cases of refractory mixed constipation admitted between February 2009 and December 2010 in Nanjing General Hospital of Nanjing Military Command were analyzed. Group A was performed Jinling procedure. Group B was performed laparoscopic assisted total colectomy with ileorectal side-to-side anastomosis. Results Primary outcomes included operation time, first flatus time, Wexner constipation score, gastrointestinal quality of life index （GIQL1）, stool frequency, incidence of diarrhea, diarrhea severity, satisfaction, contentment, serum electrolyte level and surgical complications were observed after operation 1 months, 3 months, 6 months, 12 months until 24 months. Postoperative Wexncr constipation score and GIQLI both in two Groups were improved significantly compared with preoperative data （P〈0.05）. Postoperative stool frequency, incidence of diarrhea, contentment, Wexner constipation score, GIQLI and progress of recovery of Group A were superior to Group B （P〈O.05）. There was no significant difference in postoperative surgical complication between 2 groups （P 〉 0.05）. The incidence of adhesive ileus in Group B was higher than Group A significantly. Conclusion Jinling procedure is superior to total colectomy with ileorectal side-to-side anastomosis in clinical outcome for refractory mixed constipation. Patients can get better quality of life and satisfaction besides relieving the constipation.