金陵术治疗顽固性混合型便秘的手术要点和疗效评价  

Operation key points and efficacy evaluation of Jinling procedure for mixed refractory constipation

作　　者：姜军[1] 陈启仪[1] 

机构地区：[1]南京军区南京总医院普通外科研究所,210002

出　　处：《中华胃肠外科杂志》2016年第12期1329-1334,共6页Chinese Journal of Gastrointestinal Surgery

基　　金：全军临床高新技术重大项目（2010gxjs025）;江苏省临床医学科技专项基金资助项目（BL2012006）

摘　　要：当药物治疗及生物反馈、骶神经刺激等治疗无效时，手术成为治疗顽固性便秘患者的最终选择。顽固性功能性便秘分为结肠慢传输、出口梗阻和混合型。结肠慢传输和出口梗阻两类病理变化可互为因果、恶性循环。高达90.2%的便秘为混合型，因此，手术治疗时需同时纠正这两类病理变化。金陵术应用结肠次全切除联合升结肠-直肠大口径侧侧吻合术，同时解决慢传输和出口梗阻两类病理生理变化。自2001年1月至2016年6月，南京军区南京总医院已实施金陵术1 768例，经长期随访结果显示，金陵术能有效改善排便功能和胃肠生活质量，有较高的排便满意率，同时围手术期并发症发生率较低。随着手术微创化、手术器械的进展、加速康复外科理念以及围手术期处理的不断更新和进步，该术式安全性和有效性亦在不断提高。通过长期的临床和基础研究，本中心已形成以金陵术为中心，肠道微生态治疗为基础，药物、生物反馈和骶神经刺激治疗为辅的顽固性便秘综合治疗策略。or chronic transit constipation （STC） , surgery should be considered when all pharmacological interventions, biofeedback, and sacral nerve stimulation failed to relieve severe symptoms. Chronic functional constipation can be subdivided into three subtypes： colonic slow-transit constipation, outlet obstruction and mixed refractory constipation. The pathological changes of colonic slow transit and outlet obstruction constipation can influence each other. Mixed refractory constipation accounts for 90.2% of chronic constipation. Therefore the surgery procedure should solve two types of pathological changes at the same time. The Jinling procedure combines subtotal colectomy and side-to-side cecorectal anastomosis, aiming to solve the coexistence of obstructive defecation and slow-transit constipation in one operation. A total of 1 768 patients with mixed refractory constipation received Jinling procedure from January 2001 to June 2016. Our clinical practice indicates that the Jinling procedure is safe and effective for refractory slow-transit constipation associated with obstructive defecation, with minimal major complications, significant improvement of quality of life, and a high satisfaction rate after long-term follow up. The safety and efficacy of Jinling procedure are improved continually with the progress of minimally invasive surgery, surgical instruments, recovery after surgery and perioperative management. Through long-term clinical and basic research, our institute has formed the comprehensive treatment strategy, such as Jinling procedure, intestinal microecological treatment, medication, biological feedback and sacral nerve stimulation in the treatment of functional constipation.

关 键 词：顽固性便秘 金陵术 肠道微生态治疗 

分 类 号：R657.1[医药卫生—外科学]