慢传输型便秘结肠次全切除术后盲肠直肠吻合方式的探讨

Investigation on the cecum and rectum anastomosis after colon subtotal resection in patients with slow transit constipation

目的探讨慢传输型便秘行结肠次全切除术后更合理的盲肠直肠吻合方式。方法对兰州军区兰州总医院连续收治并进行手术治疗的34例STC患者的临床资料进行回顾性分析,男性3例,女性31例;年龄36~75岁,平均60.5岁。所有患者均选择行结肠次全切除盲肠直肠吻合,手术在常规开腹或是腹腔镜辅助下进行,盲肠直肠吻合方式采用回盲瓣对侧的盲肠侧壁与直肠残端进行端侧吻合。结果传统开腹施行手术18例,腹腔镜辅助手术16例。术后1~3天开始排便,6~20次/d,术后第5-6天时排便次数逐渐减少。22例患者在术后10天时大便次数减少至8次/d以内;10例患者术后出现稀水样便伴肛门疼痛,经口服易蒙停、思密达等对症处理后好转。术后发生吻合口瘘1例、切口感染5例、尿潴留2例、炎性肠梗阻2例。30例患者得到随访2月至8年,大便次数保持在1-6次/d。2例患者7年后诉肛门坠胀,排便不净感。1例患者于术后4.5年时出现不完全性肠梗阻,经保守治疗后痊愈。27例患者术后立即感觉治疗效果满意,占80%;随访过程中,所有患者自觉症状均较术前改善明显,对手术治疗满意。无围手术期死亡。结论对于确实需要手术治疗的STC患者,结肠次全切除盲直端侧吻合可以作为术式选择之一。

Objective To investigate the cecum and rectum anastomosis for patients with slow transit constipation ( STC ) treated with subtotal colon resection .Methods Thirty-fourcases ( 3 were male and 31 females;age 36-75 years,mean 60.5 years) with STC continuously admitted for surgery at Lanzhou General Hospital of Lanzhou Military Region .Clinical data were retrospectively analyzed .All patients were treated with subtotal colectomy and rectal cecum anastomosis in conventional open surgery or laparoscopic assisted conduct . Cecum rectal anastomosis using the ileocecal valve contralateral side wall of the cecum and rectum stump side anastomosis was performed.Results Implementation of traditional open surgery in 18 cases,16 cases of laparoscopic-assisted surgery .Start of the bowel movement at 1 to 3 days after surgery with 6-20 times/d, gradually reduce the number of bowel movements after the first 5-6 days.bowel movement reduced to eight times in 10 days after stool frequency/d or less in 22 patients.10 patients with postoperative watery stools with anal pain,oral Imodium,Smecta and other symptomatic treatment improved .Complications were anastomotic fistula in one case , wound infection in five cases , urinary retention in 2 cases and inflammatory bowel obstruction in two cases .30 patients were followed up in 2 months to 8 years,stool frequency is maintained at 1-6 times/d.Two patients complained of anal swelling and not a net sense defecation after seven years .One patient with incomplete intestinal obstruction in 4.5 years after surgery .27 cases were satisfied with the feeling of immediate treatment , accounting for 80%.During follow-up, all patients symptoms were improved significantly,surgical treatment satisfaction .No perioperative deaths happen .Conclusions Subtotal colectomy straight blind side anastomosis can be used as one of the surgical options for patients with refractory idiopathic STC.