经自然腔道取标本的腹腔镜全结肠切除术治疗结肠慢传输型便秘的疗效观察

Laparoscopic total colectomy via natural orifice specimen extraction surgery for treating colonic slow transit constipation

目的探讨经自然腔道取标本的腹腔镜全结肠切除术治疗结肠慢传输型便秘(STC)的疗效。方法回顾性分析2016年1月至2020年9月于佛山市第一人民医院肛肠外科运用经直肠取标本的腹腔镜全结肠切除术治疗的26例STC患者的临床资料,观察记录手术相关情况(术中出血量、手术时间、切除肠管长度、术后恢复进食时间、术后首次排气时间及术后住院时间)、术后1个月并发症发生情况、术后病理情况、胃肠道生活质量评分、Wexner便秘评分、PAC-SYM评分、Wexner肛门失禁评分、Bristol粪便性状分级评分及排粪次数。结果所有患者均顺利完成手术,无手术死亡病例,无中转开腹及改腹壁切口取标本情况。平均手术时间为(240±34)min,平均术中出血量为(56±12)mL,平均切除肠管长度(30±12)cm,平均术后首次排气时间为(3.6±1.2)d,平均术后恢复进食时间为(4.1±1.3)d,平均术后住院时间为(7.9±2.1)d。无吻合口漏及腹腔感染等严重并发症病例;11例(42.3%)患者严重腹泻,排粪次数超过10次/d;3例患者(11.5%)发生术后粘连性肠梗阻,均经保守治疗缓解。切除肠管病理检查结果回报肠壁神经节细胞明显减少12例,发生比例为46.1%(12/26)。患者术后3个月的胃肠道生活质量评分高于术前,Wexner便秘评分、PAC-SYM评分低于术前,Wexner肛门失禁评分、Bristol粪便性状分级评分及排粪次数少于术后1周,差异均有统计学意义(均P<0.05)。结论经自然腔道取标本的腹腔镜全结肠切除术治疗STC的疗效确切,术后患者排粪情况得到改善,生活质量提高,具有一定的临床推广价值。

Objectives To investigate the effectiveness of laparoscopic total colectomy via natural orifice specimen extraction surgery(NOSES)for treating colonic slow transit constipation(STC).Methods This was a retrospective analysis of 26 patients with STC treated at the Department of Anorectal Surgery,The First People’s Hospital of Foshan,between January 2016 and September 2020.All patients underwent laparoscopic total colectomy via NOSES.Intraoperative blood loss,duration of surgery,length of resected intestine,time to postoperative food intake,time to the first postoperative flatulence,duration of postoperative hospitalization,complications at 1 month after surgery,pathology,gastrointestinal quality of life score,the Wexner constipation score,the Patient Assessment of Constipation Symptoms(PAC-SYM)score,the Wexner incontinence score,the Bristol stool scale,and the number of bowel movements were recorded.Results All surgeries were uneventful.There was no death related to the surgery,conversions to open surgery,or conversions to take specimen through abdominal wall incision.The mean(SD)duration of surgery was240(34)min.The mean(SD)intraoperative blood loss was 56(12)mL.The mean(SD)length of resected intestine was 30(12)cm.The mean(SD)time to the first postoperative flatulence was 3.6(1.2)days.The mean(SD)time to postoperative food intake was4.1(1.3)days.The mean(SD)duration of postoperative hospitalization was 7.9(2.1)days.There were no severe complications such as anastomotic leakage or abdominal infection.Eleven(42.3%)patients had severe diarrhea with daily bowel movements of over ten times.Three(11.5%)patients had postoperative adhesive intestinal obstruction,all of which were relieved after conservative treatment.Pathology of resected intestine showed that 12 had marked reduction of ganglion cells,with an overall rate of46.1%(12/26).Three months after surgery,the gastrointestinal quality of life score increased significantly,and the Wexner constipation score and PAC-SYM score decreased significantly compared with before surgery(P<0.05).The Wexner incontinence score,the Bristol stool scale and the number of bowel movements 3 months after surgery were significantly less than 1 week after surgery(P<0.05).Conclusion Laparoscopic total colectomy via NOSES is effective for treating colonic STC.It is associated with improved bowel movement and quality of life.It has a large potential for wider clinical applications.