结肠次全切除回肠乙状结肠吻合术与盲肠直肠吻合术治疗慢传输型便秘疗效对比研究  

Comparison of subtotal colectomy with cecorectal anastomosis and ileosigmoidal anastomosis for the treatment of slow transit constipation

作　　者：米东飞 王博[1] 赵发[1] 赵士彭[1] 

机构地区：[1]河北医科大学第三医院肛肠外科,石家庄050051

出　　处：《疑难病杂志》2016年第3期287-291,共5页Chinese Journal of Difficult and Complicated Cases

基　　金：河北省2015临床医学优秀人才培养和基础课题研究项目(361005)

摘　　要：目的对比结肠次全切除术一回肠乙状结肠吻合术(ISA)和结肠次全切除术一盲肠直肠吻合术(CRA)治疗慢传输型便秘的疗效。方法选择2006年1月—2013年12月在河北省大肠肛门病研究中心就诊的62例慢传输型便秘患者,按照随机数字表法将入选患者分为结肠次全切除一回肠乙状结肠吻合术组(ISA组)、结肠次全切除一盲肠直肠吻合术组(CRA组),每组31例。比较2组手术时间、术中出血量、术后住院日、术后止泻剂的使用、切口感染、吻合口漏、每周排便次数、腹胀评分、腹痛评分、大便性状、并发症发生率、手术满意度评分、胃肠生活质量评分(GIQLI)。结果 2组手术时间、术中出血、术后住院天数、切口感染、吻合口瘘方面比较差异均无统计学意义(P>0.05),ISA组止泻剂使用比例显著低于CRA组(P<0.05)。术后疗效ISA组优于CRA组(x2=4.279,P<0.05)。随访期间,2组患者每周排便次数、腹胀评分、腹痛评分等指标均较术前有明显改善(P均<0.01),ISA组术后每周排便频率、腹胀评分、并发症发生率均明显低于CRA组(t=2.165、2.021、11.273,P<0.05)。ISA组大便性状优良率、手术满意度评分、GIQLI明显高于CRA组(t=6.513、3.663、5.310,P<0.05)。结论手术治疗慢传输型便秘时,结肠次全切除一回肠乙状结肠吻合术优于结肠次全切除一盲肠直肠吻合术,除了缓解便秘症状外,患者可获得更高的满意度和生活质量。Objective The aim of the study was to compare the efficacy of ileosigmoidal anastomosis（ISA） with cecorectal anastomosis（CRA） after subtotal colectomy in patients with slow-transit constipation.Methods From January2006 to December 2013,62 patients who were confirmed slow transit constipation in Research Center of Coloproctology of Hebei Province were enrolled,according to randomly number table,they were divided into ISA and CRA group with 31 cases each group.The operation time,bleeding volume during operation,postoperative hospital stay,use of postoperative antidiarrheal agents,incision infection,anastomotic leakage,frequency of defecation a week,abdominal bloating score,abdominal pain score,properties of defecation,incidence of complications,operation satisfaction score,gastrointestinal quality of life index（CIQLI） in both groups were compared.Results Postoperative defecation frequency,abdominal pain score,abdominal bloating score both in two groups were improved significantly compared with preoperative data（P〈0.05）.Compared with the CRA group,defecation frequency.abdominal bloating score and postoperative complications in ISA group were lower than those in CRA group,there were significant differences（t =2.165,2.021,11.273,P〈0.05）;but properties of defecation,operation satisfaction score and GIQLI in ISA group were significantly better than those in CRA group（t =6.513,3.663,5.310,P〈0.05）.Conclusion Ileosigmoidal anastomosis is superior to cecorectal anastomosis for slow transit constipation,patients can get better quality of life and satisfaction besides relieving the constipation.

关 键 词：慢传输型便秘 结肠次全切除 回肠乙状结肠吻合术 盲肠直肠吻合术 

分 类 号：R656[医药卫生—外科学]