腹腔镜结肠次全剔除创面腹膜化处理联合经自然腔道取标本手术治疗慢传输型便秘6例

Laparoscopic Subtotal Colectomy With Wounds Covered With Peritoneum Combined With Natural Orifice Specimen Extraction Surgery for Slow Transit Constipation: Report of 6 Cases

目的探讨结肠次全剔除后创面腹膜化处理联合经自然腔道取标本手术(natural orifice specimen extraction surgery,NOSES)治疗慢传输型便秘的安全性、可行性。方法2017年1~12月我科对6例慢传输型便秘行腹腔镜下结肠次全剔除术,关闭暴露的腹膜后创面,经自然腔道取标本。结果6例均顺利完成手术,手术时间(216±44)min,术中出血量(65±35)ml。术中快速病理示乙状结肠断端有神经节存在,提示病变结肠已切除。标本顺利经自然腔道取出。术后(18±3)h排气排便,术后(12±3)d顺利出院,住院期间无并发症发生。1例术后出现轻度排便失禁,口服止泻剂后3~5d改善。术后3d大便9~21次/d,术后1个月4~10次/d,术后3个月2~8次/d,术后>6个月1~5次/d。6例随访7~14个月,平均9个月,无腹胀及便秘发生。结论结肠次全剔除后创面腹膜化处理联合NOSES治疗慢传输型便秘安全、可行。

Objective To investigate the safety and feasibility of subtotal colectomy with wounds covered with peritoneum combined with natural orifice specimen extraction surgery (NOSES) for slow transit constipation (STC).Methods A total of 6 cases of STC in our department from January 2017 to December 2017 were treated with laparoscopic subtotal colectomy.We completely closed the exposed retroperitoneal wound and performed NOSES.Results The operation was completed successfully in all the 6 cases.The surgical time was (216±44) min,and the bleeding volume during operation was (65±35) ml.During the operation,the rapid pathological examination showed "ganglia were located at the surgical end of colon sigmoideum",indicating that the "diseased colon" had been removed.The specimens were extracted from natural orifice successfully.Defecation took place at (18±3) h after operation and the patients were discharged from hospital after recovery at (12±3) d after the operation.No complication occurred during hospitalization.One patient had mild fecal incontinence after the operation and got improved with oral antidiarrheics for 3-5 days.Defecation took place 9-21 times/day at 3 days after operation,4-10 times/day at one months later,2-8 times/days at 3 months later,and 1-5 times/day at 6 months after operation.Postoperative follow-up period was 7-14 months (mean,9 months).No abdominal distension or constipation occurred.Conclusion The subtotal colectomy with wounds covered with peritoneum combined with NOSES for slow transit constipation is safe and feasible.