腹腔镜下结肠旷置术治疗结肠慢传输性便秘的临床研究  

Laparoscopic colonic exclusion for treating slow transit constipation patients

作　　者：付焱[1] 李恒[1] 代全武[1] 刘全[1] 黄东[1] 孙敏[1] 但超[1] 汪胜胜[1] 

机构地区：[1]湖北医药学院附属太和医院普外4科,十堰442000

出　　处：《临床外科杂志》2013年第4期255-257,共3页Journal of Clinical Surgery

摘　　要：目的总结腹腔镜下结肠旷置术治疗慢传输型便秘（STC）的体会。方法23例STC患者，行腹腔镜下结肠旷置术。对患者的临床资料、手术相关指标及术后随访结果进行分析。采用胃肠道生活质量评分及Wexner便秘评分进行术后长期随访评估手术疗效。结果23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、肛门失禁等并发症发生。术后第一天进流质饮食，平均1．5d排气，2d排便。手术后平均住院时间7d。术后随访1。48个月，患者便秘症状指标明显改善，均达到治愈标准。胃肠生活质量术前评分为（79．2±15．8）分，术后3个月（92．3±12．7）分，术后6个月（103．5±9．2）分，术后12个月（107．9±9．8）分，术后24个月（112．3±10．3）分，随访中显示持续下降，与术前比较，差异均有统计学意义（P〈0．05）。Wexner便秘评分由术前的（19．2±4．1）分降至术后3个月的（8．3±2．1）分，差异亦有统计学意义（P〈0．05）；便秘评分的下降一直维持到术后24个月。结论腹腔镜结肠旷置术整合双重微创优势，近期疗效和生活质量满意，是治疗STC的微创术式。Objective To investigate the feasibility and efficacy of laparoscopic colonic exclusion （CE） for severe slow transit constipation （STC）. Methods Twenty-three patients with STC underwent laparoscopic CE. The general clinical data, related surgical indications and follow-up time were analyzed. Gastrointestinal quality of life index（GIQLI） and Wexner scale were collected to evaluate the long-term outcomes of surgery. Results All the procedures were successfully performed. No complications such as a- nal anastomotic fistula, pelvic infection, anastomotic stenosis, adhesive intestinal obstruction and inconti- nence occurred. All patients took liquid diet on the first day after the operation. The mean exhaust time was 1.5 d, the mean defecation time was 2 d and the average hospital stay was 7 d. The mean follow-up time af- ter surgical treatment was 1 -48 months. All patients＂ STC symptoms improved and reached the curative criterion. The GIQLI increased from 79.2 _＋ 15.8 preoperatively to 92.3 ~ 12.7 at 3 months,103.5 ＋9.2 at 6 months,107.9 -＋9.8 at 12 months,and 112.3 -＋ 10.3 at 24 months（P 〈0. 01 ）. Wexner score de- creased from 19.2 -＋4.1 preoperatively to 8.3 -＋ 2.1 at 3 months follow-up（ P 〈 0.01 ）. The decrease of Wexner score sustained until 24 months after operation. Conclusions The laparoscopic colonic exclusion integrates the benefits of micro-surgery by multiplicating its advantages further. As a minimally invasive surgery, the short- term outcomes and patients＇life quality of the procedure are satisfactory.

关 键 词：慢传输型便秘 腹腔镜 结肠旷置术 生活质量 

分 类 号：R574.4[医药卫生—消化系统]