腹腔镜全结肠加部分直肠切除回直肠吻合术治疗混合型便秘25例疗效分析

Laparoscopic total colectomy with partial rectotomy for refractory constipation:an analysis of 25 cases

目的探讨腹腔镜全结肠加部分直肠切除回直肠吻合术治疗混合型便秘的有效性及安全性。方法回顾性分析2020年1月至2021年1月上海交通大学医学院附属瑞金医院收治的符合手术指征的25例混合型便秘病人的临床资料,均行腹腔镜全结肠加部分直肠切除回直肠吻合术。随访观察病人术后胃肠道功能恢复情况、术后并发症、住院时间、病人满意度、便秘症状改善情况及心理状态。结果所有25例病人均顺利完成手术,术后首次排气时间为(49.9±16.5)h,首次排便时间为(66.2±26.6)h,住院时间(9.2±4.7)d。术后病人恢复排便后呈现不同程度的大便次数增加,为(13.8±9.3)次/d。术后6个月逐步改善至(5.2±3.9)次/d,术后1年为(3.8±4.5)次/d。病人满意度为(85.3±27.9)分,便秘治疗有效率为92.0%。部分便秘病人术后仍合并焦虑和(或)抑郁状态,便秘复发病人中焦虑和(或)抑郁人群的比例明显高于便秘缓解病人,差异有统计学意义(P<0.05)。结论腹腔镜全结肠加部分直肠切除回直肠吻合术治疗混合型便秘安全、可行,病人术后恢复快。

Objective To investigate the efficacy and safety of laparoscopic total colectomy with partial proctocolectomy and ileorectal anastomosis in the treatment of mixed constipation.Methods analyzed the clinical data of 25 patients with mixed constipation who underwent surgical treatment from January 2020 to January 2021 in Ruijin Hospital of Shanghai Jiao Tong University School of Medicine,Shanghai Minimally Invasive Surgery Center.Postoperative gastrointestinal function recovery,postoperative complications,length of hospital stay,patient satisfaction,improvement of constipation symptoms and psychological status of the patients were followed up.Results postoperative first exhaust time of(49.9±16.5)h,defecation time of(66.2±26.6)h,and a hospital stay of(9.20±4.70)d.After the patients resumed defecation,the number of stools increased in different degrees,which was(13.8±9.3)times/d.It gradually improved to(5.2±3.9)times/d 6 months after operation,and(3.8±4.5)times/d 1 year after operation.Patient satisfaction was(85.3±27.9)points,and the effective rate of constipation treatment was 92.0%.Some patients with constipation still have anxiety and/or depression after surgery,and the proportion of anxiety and/or depression in patients with constipation recurrence is significantly higher than that in patients with constipation relief,the difference was statistically significant(P<0.05).Conclusion anastomosis is a reasonable operation for the treatment of mixed constipation,which reflects the advantages of safety and quick postoperative recovery in laparoscopic surgery.