全结肠旷置一回直肠侧侧吻合术治疗老年顽固性慢传输型便秘的疗效观察

Retrospective series of side-to-side ileosigmoidostomy shunting surgery for the treatment of slow transit constipation in elderly patients

目的通过对全结肠旷置一回直肠侧侧吻合术治疗老年顽固性慢传输便秘的临床资料分析，探讨该术式的临床疗效。方法回顾性分析2010年6月—12017年7月在湖北文理学院附属医院（襄阳市中心医院）行全结肠旷置、回直肠侧侧吻合术治疗顽固性慢传输型便秘的67例老年患者的临床资料。通过电话及门诊随访患者围手术期并发症和排便情况，比较患者术前、术后Wexner便秘评分及胃肠生活质量评分。采用SPSS19．0软件进行统计学分析，计量资料以（露±s）表示，采用独立样本t检验，计数资料以例（％）表示，采用∥检验。结果所有患者均顺利完成手术，术后采取电话及门诊随访，随访时间6—29个月，无一例出现术后严重并发症及死亡。手术时间（55±4）min，术中出血量为（30±2）ml，住院时间（13±3）d，第一次排便时间为术后（5．1±2．8）d。术后切口感染2例，结肠旷置综合征14例，其中12例行灌肠、口服肠道益生菌及肠道动力药物后明显好转，仅2例严重病例因反复腹胀、恶心腹痛等，行回肠末端造口术。术后6个月仅5例患者需口服少许乳果糖辅助排便外，其余患者排便良好。术后6个月、12个月Wexner便秘评分、胃肠生活质量评分与术前对比仍有统计学意义。结论全结肠旷置、回直肠侧侧吻合术，为治疗老年顽固性便秘的一种有效术式，但远期易发生结肠旷置综合征等，需待临床进一步解决。

To evaluate the chnical and functional outcomes of Side-to-Side Ileosigmoidostomy Shunting Surgerys for the treatment of elder STC patients. Methods The clinical data of 67 patients all more than 63 years old with severe idiopathic STC treated with this novel approach between June 2010 and July 2017 were retrospectively analyzed. The perioperative complications and defection conditions were followed up by telephone and outpatient. The Wexner constipation score and gastrointestinal tract were compared before and after the operation. SPSS 19.0 software was used for statistical analysis. Independent sample t test was used for measurement data, t and ）（2 test were used for comparison of count data. Results All the patients received their operations successfully without deaths or serious complication. The center follow-up period （from outpatients or phone） was 12 months （6-29 months）, only 16 patients developed complications including 2 and 14 total colonic exclusion. 12 of the 14 got better obviously after enema and taken dynamic drugs, Only 2 patients with repeated abdominal pain and distention received jejunostomy. Six months after the operation, only 5 patients needed to take some drugs for defectation. Wexner constipation scores and Gastrointestinal Quality of Life Index （GIQLI） has improved obviously after 6 months and 12 months. Conclusions The novel surgical procedure, side-to-side ileosigmoidostomy Shunting Surgery that practised in our department, is an easy, safe and effective for the treatment of selected elderly patients with STC. Large-sample, randomized, controlled analyses are worth to investigate its clinical effects.