结肠全切除对比结肠次全切除对顽固性慢传输型便秘疗效观察

Comparative study of total colectomy with subtotal colectomy for intractable slow transit constipation

目的探讨结肠全切除对比结肠次全切除对顽固性慢传输型便秘(STC)临床疗效。方法选取2014年1月至2016年1月惠州市第一人民医院收治并确诊为STC患者78例,依据随机数字表法将其随机分为全切除组(39例,行结肠全切除、回直肠吻合术)和次全切除组(39例,行结肠次全切除、逆蠕动盲直肠吻合术),记录两组患者手术时间、术中出血量,以及术后住院时间、2周内止泻药使用比率、并发症情况和Wexner肛门失禁评分,并对患者随访12个月,随访内容包含Wexner便秘评分、顽固性腹泻率和患者满意度。结果两组患者术中出血量、手术时间和术后排气时间对比差异无统计学意义;全切除组术后住院时间、止泻药使用比率均高于次全切除组,差异有统计学意义(t=3.016,P=0.021;χ~2=4.993,P=0.008)。两组患者术后Wexner便秘评分逐渐降低,术后12个月时全切除组评分明显低于次全切除组,差异有统计学意义(χ~2=4.100,P=0.007);两组患者术后顽固性腹泻率对比差异无统计学意义,全切除组患者满意度高于次全切除组,便秘复发率低于次全切除组,差异均有统计学意义(χ~2=3.175、4.905、3.884,P=0.227、0.027、0.019)。结论结肠全切除手术和结肠次切除手术在顽固性慢传输型便秘治疗中都有较好的疗效,结肠次全切除手术后患者短期内效果较好,而结肠全切除患者的长期效果较好。

Objective：To compare the clinical effect of total colectomy with subtotal colectomy for intractable slow transit constipation （STC）. Methods：From January 2014 to January 2016, seventy-eight cases of STC were diagnosed in the First People＇s Hospital of Huizhou City, and according to random number table method randomly divided into total resection group （39 cases underwent total colectomy and ileorectal anastomosis） and subtotal resection group （39 cases underwent subtotal colectomy and antiperistaltic cecoproctostomy）. Data of patients were recorded with operation time, bleeding volume during operation, and postoperative hospitalization time in 2 weeks, antidiarrheals use ratio, complications and Wexner incontinence score, and patients were followed up for 12 months for Wexner constipation score, intractable diarrhea rate and patient satisfaction. Results：There was no significant difference between the two groups in intraoperative bleeding volume, exhaust time and operative time. Postoperative hospitalization time and antidiarrheal use ratios of the total resection group was higher than the subtotal resection group, the difference was statistically significant （t=3.016, P=0.021; χ2=4.993, P=0.008）. Postoperative Wexner constipation score decreased gradually after 12 months, and total resection group were significantly lower than subtotal group, the difference was statistically significant （ χ2=4.100, P=0.007）. There was no significant difference for intractable diarrhea rate, while patients satisfaction and constipation recurrence is higher in total resection group than the subtotal resection group, the differences were statistically significant （ χ2=3.175, 4.905, 3.884, P=0.227, 0.027, 0.019）. Conclusions：Total resection of the colon and secondary resection of the colon have good effect in the treatment of intractable STC. The short term effect is better for the total resection of the colon, and the long term effect for subtotal resection.