全结肠旷置加回直逆蠕动侧侧吻合术治疗高龄慢传输型便秘  

Total colonic exclusion plus side to side ileorectal antiperistaltic anastomosis in the treatment for elderly patients with slow transit constipation

作　　者：丁召[1] 陈钰[2] 江从庆[1] 吴云华关[1] 郑科炎[1] 秦前波[1] 钱群[1] 

机构地区：[1]武汉大学中南医院结直肠肛门外科湖北省肠病医学临床研究中心肠病湖北省重点实验室,武汉430071 [2]湖北省襄阳市中心医院普通外科

出　　处：《中华胃肠外科杂志》2013年第7期637-640,共4页Chinese Journal of Gastrointestinal Surgery

基　　金：武汉大学自主科研项目（303274981）

摘　　要：目的评估全结肠旷置、回直逆蠕动侧侧吻合术治疗高龄特发性结肠慢传输便秘的安全性和可行性。方法回顾性分析2009年5月至2011年9月间在武汉大学中南医院接受全结肠旷置、回直逆蠕动侧侧吻合术的13例高龄结肠慢传输型便秘患者的临床资料。结果13例患者中男5例，女8例，年龄63～82（平均74）岁，病程7～38（中位10）年。手术时间（55±4）min，术中出血量（30±2）ml，术后住院时间10～16（平均11．4）d，术后首次排粪时间为术后2N8（平均4）d。无手术意外及术后严重并发症发生。术后随访6～29（中位12）月。术后12个月患者每日排粪3-4次，无便秘复发或腹泻。术后14个月发生盲袢综合征1例。术后6个月，Wexner便秘评分较术前显著降低（5．4±2．1比22．8±3．3，P〈0．05），胃肠道生活质量指数较术前显著提高（120．8±13．0比93．6±20．5，P〈O．05）。结论全结肠旷置、回直逆蠕动侧侧吻合术为高龄结肠慢传输便秘患者的一种安全、有效、简便的手术方式，可显著的缓解患者的临床症状。Objective To evaluate the feasibility and safety of total colonic exclusion plus side to side antiperistahic ileorectal anastomosis in the treatment for elderly patients with slow transit constipation （STC）. Methods Clinical data of 13 patients with severe idiopathic STC undergoing the above novel procedure in Zhongnan Hospital of Wuhan University between May 2009 and September 2012 were retrospectively analyzed. The Wexner constipation score and gastrointestinal quality of life index （GIQLI） before and 6 months after operation were compared. Results There were 8 female and 5 male patients, with a mean age of 74 years（range 63-82 years）. No procedure-related deaths or any serious complication occurred. The length of follow-up ranged from 6 to 29 months（median, 12 months）. The duration of surgery was （55±4） min. Blood loss was （30±2） ml. The postoperative hospital stay ranged 10 to 16 days （mean 11.4 days）. The first bowel movement occurred in the 4th day（range 2nd- 8th day） after operation. There was no intestinal occlusion and anastomotic leakage that required surgery in all the patients. No fecal incontinence or constipation recurrence was found. One patient developed blind loop syndrome 14 months after operation. Postoperative complications included incision fat liquefaction in 2 cases, anorectal bearing-down while bowel movement in 2 cases, and minor defecatedifficulty needed glycerin enema in 1 case. Wexner scores was significantly improved from 22.8±3.3 before operation to 5.4±2.1 six months after operation （P〈0.05）. GQLI was significantly increased from 93.6±20.5 before operation to 120.8±13.0 six months after operation （P〈0.05）. At 6 months after operation, the outcome was excellent in 11 patients and good in 2 patients. Conclusion Total colonic exclusion plus side to side antiperistaltie ileorectal anastomosis is easy, safe and effective in the treatment for selected elderly patients with STC.

关 键 词：便秘 慢传输型 高龄患者 全结肠旷置 逆蠕动吻合 治疗效果 

分 类 号：R656.7[医药卫生—外科学]