慢性顽固性便秘30例手术治疗分析  

Surgical treatment of chronic constipation：a report of 30 cases

作　　者：王桂华[1] 胡俊波[1] 杨传永[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院外科,武汉430030

出　　处：《临床外科杂志》2010年第5期320-322,共3页Journal of Clinical Surgery

摘　　要：目的研究手术治疗慢性便秘的临床价值、手术适应证及其对肠道功能的影响。方法结肠慢传输型便秘患者25例，结肠慢传输型便秘合并出口梗阻型便秘患者1例，成人巨结肠致便秘患者4例，均行手术治疗。术后随访记录患者排便情况、并发症、生活质量。结果所有患者术后无严重并发症及死亡。30例患者术后生活质量均得到明显改善，随访6—36个月，术后3个月内大便次数均增多，平均每日4．5次（3～6次），软便；以后大便次数逐渐减少，1年后每日1—3次成形大便，无一例需服止泻剂。术后2例患者出现粘连性肠梗阻，1例术后出现吻合口漏，其他患者均未出现肠梗阻、腹泻、腹痛、排便失禁等并发症。结论对排便功能障碍患者，有选择性的行结肠次全切除并盲直肠吻合术，近期疗效理想，特别对于慢传输型便秘疗效较好，但长期疗效尚需进一步研究。Objective To examine the clinical value of surgery in the treatment of chronic constipation, surgical indication and the effect of surgical treatment on bowel function. Methods This cohort included 25 patients with chronic slow - transit constipation, 1 patient with mixed chronic constipation and 4 patients with megaeolon. All the patients underwent subtotal colectomy. Before the operation, all patients were laxative dependant, with a mean bowel frequency of more than 5 days. The following information was collected during the period of follow - up ： number of bowel movements ; stool consistency ; complications; quality of life. Results There was no mortality or major postoperative morbidity. Thirty patients （ 100% ） reported that the quality of life was improved. All cases were followed up for 6 to 36 months. Within the first 3 months after the operation, bowel frequency was a mean of 4. 5 （ range 3 - 6）, with a semitiquid stool consistency. Then the bowel frequency decreased with time. About 1 year after the operation, the bowel frequency dropped to 1 to 3 motions/per day, with a semisolid stool consistency. No patients needed to use antidiarrheal medicine. Two patients showed adhesive ileus postoperatively, and one patient developed anastomotic leakage. No diarrhea and incontinence occurred. All the patients were completely relieved of previous symptoms and abdominal discomfort. Conclusion Subtotal colectomy is a safe and effective procedure that can be selectively used in patients with bowel dysfunction, especially in those with chronic slow - transit constipation. However, long - term efficacy of this procedure need further study.

关 键 词：结肠次全切除术 慢性便秘 

分 类 号：R657.1[医药卫生—外科学]