《便秘外科诊治指南》（2017年版）解读  

Interpretation of Chinese guidelines for the diagnosis andtreatment of constipation surgery （2017）

作　　者：刘宝华[1] 

机构地区：[1]陆军军医大学大坪医院野战外科研究所普通外科全军便秘诊治中心,重庆400042

出　　处：《中华胃肠外科杂志》2017年第12期1331-1333,共3页Chinese Journal of Gastrointestinal Surgery

摘　　要：中国医师协会肛肠医师分会于2017年更新发布了《便秘外科诊治指南》（2017年版），主要修改意见包括：（1）将便秘病因按排粪反射涉及部位分为结直肠外因素、结直肠因素、结直肠内因素三部分，更有条理性，能够明确病因部位及可能的发病机制。（2）将便秘分为慢传输型、出口梗阻型和混合型，主要考虑出口梗阻型便秘如直肠内脱垂和直肠前突手术名称的书写。（3）便秘的检查方法中。结肠传输试验增加了口服标记物后6h摄腹部x线平片时间点．能够了解胃和小肠是否有传输功能减慢。（4）便秘非手术治疗增加了微生态制剂、促动力药和促分泌药，还增加了心理治疗和中医针灸治疗。（5）慢传输型便秘的外科治疗删除了顺行结肠灌注术，直肠内脱垂的外科治疗增加了经肛门吻合器直肠切除术（STARR）。删除了直肠黏膜切除肌层折叠术（Delorme）手术，直肠前突手术增加了经直肠和经会阴入路。本文对比多版国内外便秘相关指南，对2017年版《便秘外科诊治指南》制定过程中的主要修改意见进行解读。The Chinese Society of Coloproctology （CSCP） released the updated ＂guidelines for the diagnosis and treatment of constipation surgery＂ in 2017. The major amendments include the following aspects： （1） According to defecation reflex involving parts of the classification, the cause of constipation is divided into three parts, including colorectalfactors, internal and external colorectal factors. The new division is more rational, easy to make clear the location and the possible pathogenesis. （2） Constipation is divided into slow transit constipation, outlet obstructive constipation and mixed constipation. The main consideration of this division is the name of the surgery for the outlet obstructive constipation, such as the rectal prolapse and the rectocele. （3） The 6-hour observation time point is added in the colonic transit test and to make clear whether the stomach and the small intestine has slow transit. （4） Micro ecological preparations, promoting dynamic drugs and promoting secretion drugs as well as psychological treatment and acupuncture treatment are added in non-surgical treatment of constipation （5） The antegrade colonic enema is removed from surgical treatment of slow transit constipation; in the surgical treatment of internal rectal prolapse, STARR surgery is added and Delorme surgery is deleted; transrectal and transperineal approach are added in the surgical treatment of rectocele. In this paper, we compare the domestic and international constipation-related guidelines, and summarize the main revisions in the 2017 edition of ＂guidelines for the diagnosis and treatment of constipation surgery＂.

关 键 词：便秘 外科手术 指南 

分 类 号：R656.9[医药卫生—外科学]