腹腔镜与开腹结肠全(次全)切除术治疗慢传输型便秘的疗效分析

Clinical effectiveness of laparotomy versus laparoscopic total(subtotal)colectomy in the treatment of slow transit constipation

目的评价腹腔镜结肠全(次全)切除术治疗慢传输型便秘的有效性、安全性及可行性。方法回顾性分析武汉大学中南医院结直肠肛门外科2014年8月至2017年10月接受腹腔镜手术和开腹手术治疗的慢传输型便秘病人共66例,其中腹腔镜组35例,开腹手术组31例。比较两组病人的一般情况、手术情况、术后情况、并发症及术后疗效。结果腹腔镜结肠全(次全)切除组与开腹手术组相比,两组病人一般情况、Wexner便秘评分、胃肠生活质量评分及总体并发症发生率等差异均无统计学意义(均P>0.05),腹腔镜组在术中出血量(P=0.000)、术后肠道功能恢复时间(P=0.000)、伤口并发症(P=0.000)、术后住院时间(P=0.048)等方面优于开腹组。结论腹腔镜结肠全(次全)切除术与传统开腹手术治疗慢传输型便秘同样安全、有效、可行,但腹腔镜手术创伤小,住院时间短,伤口并发症少,病人满意度高。

Objective To evaluate the safety,efficacy and feasibility of laparoscopic total（subtotal）colectomy in the treatment of slow transit constipation.Methods We retrospectively analyzed66 patients with slow transit constipation who underwent total（subtotal）colectomy from August 2014 to October 2017 in the Department of Colorectal and Anal Surgery of Zhongnan Hospital of Wuhan University,and who were classified as open group（31 cases）and laparoscopic group（35 cases）.General conditions,surgery conditions,postoperative conditions,as well as curative effectiveness were compared between the two groups.Results There was no significant difference in general conditions,Wexner constipation score and gastrointestinal quality of life index between the two groups（P〉0.05）,while there was significant difference in the volume of blood loss（P=0.000）,postoperative recovery of bowel function（P=0.000）,incidence of wound complications（P=0.000）and postoperative hospital stay（P=0.048）between the two groups.Conclusions Both the laparotomy and laparoscopic（subtotal）total colectomy are proved to be safe,effective and feasible,nevertheless,the laparoscopic total（subtotal）colectomy has the advantages of less trauma,shorter hospitalized time,less wound complications and better patient satisfacation.