腹腔镜回肠直肠侧侧吻合分流术治疗顽固性结肠慢传输型便秘的临床研究  

Laparoscopic ileo - rectal anastomosis bypass procedure for the treatment of refractory severe colon slow transit constipation

作　　者：江滨[1] 丁曙晴[1] 丁义江[1] 金洵[1] 倪敏[1] 杨忠华[1] 叶辉[1] 谭妍妍[1] 

机构地区：[1]南京中医药大学第三附属医院肛肠中心,210001

出　　处：《临床外科杂志》2010年第12期822-825,共4页Journal of Clinical Surgery

摘　　要：目的 评估腹腔镜回肠直肠侧侧吻合分流术治疗顽固性结肠慢传输型便秘（colon slow transit constipation,STC）的疗效.方法 选择2010年1月至7月间符合纳入标准的15例STC患者,行腹腔镜回肠直肠侧侧吻合分流术.收集患者的临床资料和术后随访结果进行分析.主要分析指标为：手术相关指标（手术时间,出血量,首次排气排便时间,术后进食时间,住院时间,术后并发症）;术前、术后3个月患者生活质量评分以及术后1周、1个月、3个月便质评分、便意感次数、排便次数、腹胀程度.结果 15例患者均成功施行手术,无肠瘘、盆腔感染、吻合口狭窄、切口感染、术后粘连性肠梗阻、肛门失禁发生.手术后平均住院时间（8.13±2.26）d.术后第一天进流质,平均1.5 d排气,2 d排便.术后随访3～6个月,患者便秘症状指标明显改善,均达到治愈标准.全部停用泻剂、灌肠以及其他针对STC的治疗,恢复正常饮食.Bristol便质评分达正常;术后患者生活质量指标中身体不适、心理不适、便秘相关的焦虑和关心、满意度四方面分值及总分差值均明显下降（P＜0.01）.腹胀减轻或消失.结论 回肠直肠侧侧吻合分流术治疗结肠STC近期疗效和生活质量满意,远期疗效尚待观察.Objective To investigate the efficacy of laparoscopic ileo - rectal anastomosis bypass procedure in the treatment of refractory severe colon slow transit constipation（STC）. Methods The clinical data of 15 STC patients who underwent ileo - rectal anastomosis bypass procedure from Jan. 2010 to July 2010 were analyzed retrospectively,including intraoperative bleeding, length of operation and hospitalization, time for resuming normal diet, time for exhaustion and defecation. The stool scoring, stool frequency, abdominal distension and PAC - QOL （ Patient Assessment of Constipation Quality of Life ） of these patients were also evaluated before and one and three months after the operation. Results Laparoscopic ileo - rectal anastomosis bypass procedure was successfully performed in the 15 patients. No complications such as intestinal fistula, pelvic infection or anastomotic stricture, infection of incision, postoperative adhesion bowl obstruction, diarrhea and anal incontinence occurred. All patients took fluid diet one day after the operation. The mean exhaust time was 1.5 d, and the time for defecation was 2 d, and the average hospital stay was 7 d. The mean follow - up time after surgical treatment was 3 - 6 months. PAC - QOL and constipation symptom index improved dramatically after the operation. All of the 15 patients were satisfied with their postoperative bowel movement, did not require any laxatives, enemas and other treatments for constipation, and recovered to a normal dict. Bristol score was normal and body discomfort, psychological discomfort ,anxiety and concern associated to constipation, the satisfaction and the total score difference were decreased obviously （ P 〈 0.01 ）. Conclusion The ileo - rectal anastomosis bypass procedure achieves good short -term outcomes and long -term results should be further investigated.

关 键 词：结肠慢传输型便秘 腹腔镜 回肠直肠侧侧吻合分流术 生活质量 

分 类 号：R657.1[医药卫生—外科学]