手助腹腔镜结肠次全切除联合改良Duhamel术治疗重度功能性便秘  

Efficacy and safety of hand-assisted laparoscopic subtotalcolectomy and modified Duhamel procedure for severe functional constipation

作　　者：姜军[1] 李宁[1] 朱维铭[1] 黎介寿[1] 

机构地区：[1]第二军医大学南京临床学院(南京军区南京总医院)解放军普通外科研究所,江苏南京210002

出　　处：《医学研究生学报》2007年第9期931-933,937,共4页Journal of Medical Postgraduates

基　　金：国家自然科学基金资助项目(批准号:30371392)

摘　　要：目的:观察手助腹腔镜结肠次全切除联合改良Duhamel术治疗重度功能性便秘(SFC)的近期疗效及并发症,评价其安全性和可行性。方法:2005年6月至2006年12月,对9例经非手术治疗效果欠佳的SFC患者,经过对临床症状、结肠镜检查、结肠传输试验和排粪造影等检查结果的分析,显示有明确的病理解剖和功能性异常部位,施行手助腹腔镜结肠次全切除联合改良Duhamel术治疗;观察手术安全性、术后恢复情况和并发症、便秘症状指标和术后近期随访结果。结果:8例患者手术成功,1例中转剖腹手术,术后无严重并发症,平均手术时间(284.2±26.3)min,术中出血量(141.5±65.4)ml,切口长度(10.8±1.3)cm,术后镇痛(1.8±0.6)d、肛门排气(4.2±0.6)d,下床活动(3.5±0.4)d,术后住院(9.8.±2.3)d。1例患者术后10 d出现肠梗阻症状,经内科治疗缓解,并发肺部感染和切口感染各1例。患者术后便秘症状指标明显改善[(15.4±1.6)分vs(4.2±1.4)分,P=0.000)],改善度平均为(76.3±9.5)%。患者排便频率满意率和生活质量满意率等方面获得较好结果。1例术后出现轻度便秘,应用膨胀性泻剂和促动力药后症状可缓解。结论:手助腹腔镜结肠次全切除联合改良Duhamel术获得较好的改善便秘症状满意率,且具有创伤小、出血少、安全和术后恢复快等优点。Objective ： To evaluated the feasibility, safety and short-term benefits of hand-assisted laparoscopic subtotalcolectomy and modified Duhamel procedure for severe functional constipation （SFC）. Methods ： Between June 2005 and December 2006, 9 laxative-dependent SFC patients had one motion or less per week underwent hand-assisted laparoscopic subtotalcolectomy and modified Duhamel procedure. The indication for surgery was based on failure of long-term medical therapy. The selection criteria were normal colonoscopy, abnormal colon transit time （CTF） and abnormal dynamic proctography （DPG）. The clinical manifestations, operation safety, recovery, complications, short-term bowel functional outcomes and satisfaction with quality of life were analyzed. patients and 1 patient was converted to open surgery. The Results： The Operation succeed in 8 of the mean operation time, blood loss, length of incision, times of analgetic injection, first flatus time, time to ground activity and hospital stay were （284.2 ±26.3） min,（141.5±65.4） ml,（10.8±1.3） cm, （1.8±0.6） d, （4.2±0.6） d, （3.5±0.4） d, （9.8 ± 2.3 ） d respectively. One patient developed early postoperative bowel obstruction. The postoperative outcomes with score costive gastrointestinal symptoms were significantly better than the preoperative ones （ [ 15.4 ± 1.6] vs [ 4.2 ± 1.4], P = 0. 000）. Most of the patients （ 88.9 percent） were satisfied with their bowel-movement frequency. Conclusion： Hand-assisted laparoseopie subtotaleoleetomy and modified Duhamel procedure for SFC is safe and effective option for SFC, which achieves good bowel functional outcomes and satisfactory quality of life.

关 键 词：重度功能性便秘 外科治疗 腹腔镜手术 结肠次全切除术 改良DUHAMEL术 生活质量 

分 类 号：R659.6[医药卫生—外科学]