外科手术对顽固性便秘并继发性巨结肠的疗效研究  

Outcomes after surgery for refractory constipation patients complicated with megacolon

作　　者：丁威威 姜军 冯啸波 姚安龙 刘建磊 李宁 黎介寿 

机构地区：[1]南京军区南京总医院南京大学医学院附属金陵医院全军普通外科研究所,210002

出　　处：《中华胃肠外科杂志》2014年第5期453-456,共4页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金项目青年基金（81300278）；江苏省临床医学科技专项

摘　　要：目的：探讨不同手术方式治疗顽固性便秘并继发性巨结肠的疗效。方法回顾性分析2007年6月至2013年1月在南京军区南京总医院全军普通外科研究所接受手术治疗的112例顽固性便秘并发继发性巨结肠患者的临床资料，全组患者便秘病程4～22年，其中74例既往接受过腹部中等以上手术。手术方式：（1）金陵术（结肠次全切除加升结肠-直肠后壁侧侧吻合术）81例，其中24例接受腹腔镜辅助金陵术，18例加末端回肠保护性造口术；（2）结肠全切除加末端回肠与直肠后壁侧侧吻合术18例；（3）结肠全切除加末端回肠临时造口术13例（6个月后行末端回肠与直肠后壁侧侧吻合术）。末端回肠保护性造口在术后6个月予以还纳。结果112例患者手术成功率100％，无手术相关死亡病例。术后出现的并发症包括术后早期腹泻90例（80．4％）、肛门疼痛和排粪不尽22例（19．6％）、尿潴留（去除导尿管后24～48 h内出现）16例（14．2％）、吻合口出血9例（8．0％）、吻合口瘘6例（5．4％）以及肠梗阻15例（13．4％），除6例肠梗阻患者接受肠粘连松解术后症状缓解外，其余并发症均通过保守治疗恢复良好。术后随访6月，不同术式患者Wexner便秘平均评分为5．8～8．3，与术前21．4～28．7比较，明显改善（P＜0．01）。结论顽固性便秘并继发性巨结肠外科手术治疗效果良好。Objective To explore the efficacy of different procedures for refractory constipation complicated with megacolon. Methods Clinical data of 112 patients of refractory constipation complicated with megacolon undergoing surgery in our institute from June 2007 to January 2013 were retrospectively analyzed. Of these 112 patients, the duration of constipation ranged from 4 to 22 years. Seventy-four patients had previous abdominal operations. Surgical procedures：（1）Jinling procedure （subtotal colectomy plus ascending colorectal posterior wall side-to-side anastomosis , n=81）, including 24 laparoscopy-assisted procedures, 18 terminal ileostomies. （2）total colectomy plus ileorectal side-to-side anastomosis （n=18）. （3）total colectomy plus end ileostomy, and ileorectal posterior wall side-to-side anastomosis 6 months later （n=13）. The end ileostomy was reversed 6 months after operation. Results The successful rate was 100% , and no surgery-related deaths were found. Postoperative complications included early diarrhea （90 cases, 80.4%）, anal pain and incomplete evacuation （22 cases, 19.6%）, urinary retention within 24-48 h after catheter removal （16 cases, 14.2%）, anastomosis bleeding （9 cases, 8.0%）, anastomosis leakage （6 cases, 5.4%）,and intestinal obstruction （15 cases, 13.4%）. Six patients with intestinal obstruction underwent adhesiolysis, and others were managed by conservative therapy. At the postoperative follow-up at 6 months , the Wexner constipation score was significantly reduced （5.8-8.3 vs. 21.4-28.7,P〈0.01）, and malnutrition improved as well. Conclusion Surgical intervention results in good efficacy for refractory constipation complicated with megacolon.

关 键 词：便秘 继发性巨结肠 结肠切除术 肠造口术 

分 类 号：R656.9[医药卫生—外科学]