腹腔镜金陵术对改善顽固性便秘患者焦虑抑郁状态疗效分析

Laparoscopic Jinling procedure for the improvement of anxiety and depression in patients with refractory constipation

目的初步评价金陵术对顽固性便秘患者改善焦虑抑郁状态疗效。方法回顾性分析2013年1月至2015年6月施行腹腔镜下金陵术治疗顽固性便秘10例患者资料。观察患者手术前后平均每日(周)完全自发排便(SCBM)的次数,并采用健康状况调查问卷(SF-36)、焦虑自评量表(SAS)和抑郁自评量表(SDS)比较治疗前后患者便秘症状改善对心理状态变化的影响。所有数据分析应用SPSS 17.0统计软件完成。数据以x珋±s表示,手术前后各组均数比较采用One-Way ANOVA检验,P<0.05为差异有统计学意义。结果 10例患者均康复出院,术后患者出现排粪频次明显增多,SCBM由术前每周(0.4±0.5)次,增加到术后3、6、12、24个月分别为(7.0±1.8)次/d、(5.4±1.2)次/d、(4.6±1.5)次/d和(4.6±2.1)次。SF-36评分显示患者生活质量在术后12个月后明显改善。SAS评分由术前57.6±7.7分,下降到术后3、6、12、24个月分别为(57.2±7.4)分、(51.7±6.4)分、(45.3±4.0)分和(44.3±4.2)分;术后12和24个月评分比术前显著下降,差异均有统计学意义(均P<0.01)。SDS评分由术前(54.9±7.2)分,下降到术后3、6、12、24个月分别为(53.1±7.8)分、(51.4±6.7)分、(42.8±6.4)分和(43.0±4.1)分,术后12和24个月评分比术前显著下降,差异均有统计学意义(分别P<0.01,P<0.05)。结论腹腔镜下金陵术能明显改善患者便秘症状及生活质量,进而改善了患者焦虑抑郁状态。

Objective To evaluate the efficacy of laparoscopic Jinling procedure for the improvement of anxiety and depression in patients with refractory constipation. Methods The clinical data of 10 patients with refractory constipation who had received laparoscopic Jinling procedure between January2013 and June 2015 were analyzed retrospectively. Spontaneous complete bowel movement（SCBM）evaluation before and after the procedure,the short form-36 health survey questionnaire（SF-36）,the self-rating anxiety scale（SAS）,and the self-rating depression scale（SDS） were used to evaluate whether the improvement of constipation after the procedure could change the mental state of the patients.Results No operation-associated death occurred. Increased bowel movement was observed postoperatively.SCBM increased from（0.4±0.5） / week preoperatively to（7.0±1.8） / d at 3 months,（5.4±1.2） / d at6 months,（4.6±1. 5） / d at 12 months,and（4.6±2.1） / d at 24 months. SF-36 scores showed that the quality life of the patients was significantly improved 12 months after operation. SAS score was 57.6 ±7.7 before operation,and decreased to 57.2±7.4,51.7±6.4,45.3±4.0,and 44.3±4.2 respectively at 3,6,12,and 24 months after operation. It was significant decreased at 12 and 24 months after operation（all P0.01）. SDS score was 54.9±7.2 before operation,and decreased to 53.1±7.8,51.4±6.7,42.8±6.4 and 43.0±4.1 respectively at 3,6,12,and 24 months after operation. The scores of 12 and24 months decreased significantly（P0.01 and P0.05, respectively） after operation.Conclusion Laparoscopic Jinling procedure could significantly improve the symptoms of constipation and the quality of life of the patients,while improving their anxiety and depression.