Surgical outcomes of subtotal colectomy with antiperistaltic caecorectal anastomosis vs total colectomy with ileorectal anastomosis for intractable slow-transit constipation

次全结肠切除逆蠕动盲直肠吻合对比全结肠切除回直肠吻合治疗顽固性慢传输便秘的外科疗效

Background:Few studies have compared the surgical outcomes of different surgical procedures currently used to treat refractory colonic slow-transit constipation(STC),despite the increase in the number of cases.This study aimed to analyse the long-termsurgical outcomes of subtotal colectomy with antiperistaltic caecorectal anastomosis(SC-ACRA)vs total colectomy with ileorectal anastomosis(TC-IRA)for severe STC.Methods:Between January 2005 and January 2015,we retrospectively collected clinical data of 55 patients who underwent TC-IRA(n=35)or SC-ACRA(n=20)for severe STC at our institution.The post-operative functional outcomes between the two groups were compared.Results:There were no significant differences in age(P=0.655),sex(P=0.234),period of constipation(P=0.105)and defecation frequency(P=0.698)between the TC-IRA and SC-ACRA groups.During a median follow-up period of 72 months(range,12–120 months),there were no significant differences between the TC-IRA and SC-ACRA groups regarding the median number of bowel movements per day[3(1/6–7)vs 3(1/6–5),P=0.578],Cleveland Clinic Florida Constipation Score[2(0–20)vs 2(0–19),P=0.454],Cleveland Clinic Incontinence Score[0(0–5)vs 0(0–2),P=0.333]and Gastrointestinal Quality of Life Index[122(81–132)vs 120(80–132),P=0.661].Moreover,there was no significant difference in the incidence of postoperative complications between the two groups(37.1%vs 25.0%,P=0.285).Conclusions:Our findings indicate that both TC-IRA and SC-ACRA are effective treatments for severe STC,with similar long-termoutcomes.

背景:尽管顽固性慢传输便秘(STC)病例数不断增多,但目前鲜有比较不同术式对其治疗效果的报道。本研究旨在比较次全结肠切除逆蠕动盲直肠吻合(SC-ACRA)与全结肠切除回直肠吻合(TC-IRA)的远期手术疗效。方法:回顾性收集2005年1月至2015年1月间在本中心接受TC-IRA(35例)和SC-ACRA(20例)治疗的顽固性STC患者的临床资料。比较两组患者术后功能学结果。结果:两组患者年龄(P=0.655)、性别(P=0.234)、便秘病程(P=0.105)、排便频率(P=0.698)的差异均无统计学意义。中位随访72(12-120)个月,TC-IRA组与SC-ACRA组每日排便次数分别为3(1/6-7)和3(1/6-5)(P=0.578),克利夫兰便秘评分分别为2(0-20)和2(0-19)(P=0.454),克利夫兰失禁评分分别为0(0-5)和0(0-2)(P=0.333),胃肠生活质量指数分别为122(81-132)和120(80-132)(P=0.661)。两组术后并发症发生率的差异亦无统计学意义(37.1%vs 25.0%,P=0.285)。结论:TC-IRA和SC-ACRA均可有效治疗顽固性STC,两种术式远期疗效相当。