腹腔镜联合经肛门内镜手术治疗重度功能性便秘  

Laparoscopy assisted with transanal endoscopic microsurgery in the treatment of severe functional constipation

作　　者：张志勇[1] 张亚杰[1] 李阿健 林谋斌[1] 韩意[1] 张浩波[1] 尹路[1] 

机构地区：[1]上海交通大学附属瑞金医院胃肠外科,200025

出　　处：《中华胃肠外科杂志》2014年第12期1179-1182,共4页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的：探讨腹腔镜联合经肛门内镜结肠次全切除加改良Duhamel术治疗重度功能性便秘（SFC）的安全性及疗效。方法回顾性分析2010年5月至2012年10月间在上海交通大学医学院附属瑞金医院接受腹腔镜联合经肛门内镜结肠次全切除加改良Duhamel手术治疗的10例SFC患者的临床资料，采用胃肠生活质量评分和Wexner便秘评分来评价手术疗效。结果10例患者均成功完成腹腔镜联合经肛门内镜手术，无中转开腹病例。1例患者行末端回肠造口，术后无任何并发症。手术时间（256±58） min，术中出血量（178±67） ml，术后肠道功能恢复时间（40±11） h，术后住院天数（9．0±1．5） d。仅1例患者术后1周内出现粘连性肠梗阻，经保守治疗缓解。术后1年，患者胃肠生活质量评分和Wexner便秘评分均较术前显著改善[（112±10）比（75±12）分，P＝0．000；（5．2±1．8）比（20．8±2．2）分，P＝0．000]，8例患者便秘症状明显改善，排粪次数1～3次／d；1例出现腹泻，排粪次数4～6次／d；1例患者仍有轻度便秘，2～3 d排粪1次。结论腹腔镜联合经肛门内镜结肠次全切除加改良Duhamel术为SFC提供了一种安全、有效的微创手术治疗方式。Objective To investigate the feasibility and efficacy of laparoscopic subtotal colectomy and modified Duhamel procedure combined with transanal endoscopic microsurgery （TEM） in the treatment of severe functional constipation （SFC）. Methods The clinical data of 10 patients with SFC treated by laparoscopic surgery combined with TEM between May 2010 and October 2012 in Ruijin Hospital of Shanghai Jiaotong University School of Medicine were retrospectively analyzed. The gastrointestinal quality of life index （GIQLI）, Wexner constipation scale and daily frequency of defecation postoperatively during follow-up were collected. Results All the 10 operations were successfully accomplished laparoscopic subtotal colectomy combined with TEM without abdominal incision. There was no conversion to open procedure. One case had preventive terminal ileum stoma. The mean operative time was （256±58） min. The mean blood loss was （178±67） ml. The mean time to first flatus was （40 ±11） h. There were no ureteric injury, anastomotic leak, pelvic sepsis and other complications postoperatively. There was one case of insufficient small bowel obstruction which was released by conservative treatments. The patients were discharged from the hospital in （9.0 ±1.5） d postoperatively. The GIQLI in one year postoperatively was （112 ±10） points, which indicated good results compared to （75 ±12） points preoperatively （P=0.000）. The Wexner constipation scale was 20.8 ±2.2 preoperatively and decreased to 5.2 ±1.8 at one year follow-up （P=0.000）. Conclusion Laparoscopic subtotal colectomy and modified Duhamel procedure combined with TEM provides SFC patients a safe and feasible minimally invasive surgery.

关 键 词：重度功能性便秘 外科手术 腹腔镜 经肛门内镜显微技术 

分 类 号：R657.1[医药卫生—外科学]