不同术式治疗慢传输型便秘的效果及对术后腹泻影响的比较  

Comparison the curative effect of two operation method on slow transit constipation and postoperative diarrhea

作　　者：辛建 初侃 徐国帅[1,2] 刘洪涛[1] 蔡相军[1] XIN Jian;CHU Kan;XU Guoshuai;LIU Hongtao;CAI Xiangjun(Department of Surgery,202 Hospital of PLA,Shenyang 110812,China)

机构地区：[1]中国人民解放军第202医院普通外科,沈阳110812 [2]中国医科大学研究生院,沈阳110122

出　　处：《疑难病杂志》2018年第6期580-584,共5页Chinese Journal of Difficult and Complicated Cases

基　　金：辽宁省自然科学基金指导计划项目(201602751)

摘　　要：目的观察改良Duhamel术与回肠乙状结肠吻合术(ISA)对慢传输型便秘(STC)的治疗效果以及术后腹泻的影响。方法分析2010年1月—2015年12月中国人民解放军第202医院普通外科手术治疗STC患者35例的临床资料。根据手术方式不同分为2组,改良Duhamel术组(Duhamel术组)21例,回肠乙状结肠吻合术组(吻合术组)14例。对比分析患者手术时长、术中出血量、术后肠瘘、术后继发肠梗阻、WCS评分、GIQLI评分等资料。通过重复测量方差分析2组患者及术前、术后3个月、术后6个月、术后1年、术后2年每周排便次数。结果2组患者的性别、年龄、便秘病程、术后恢复流食时间、术后放置引流管时间、术后住院时间、术后肠瘘、切口感染、术后继发肠梗阻等比较差异无统计学意义(P>0.05)。Duhamel术组手术时长与术中出血量大于吻合术组(t=2.221、2.332,P=0.033、0.026)2种术式对患者便秘情况都能起到明显改善作用,2组WCS评分与GIQLI评分手术前后比较差异均有统计学意义(t_(Duhamel组)=16.861、7.018;t_(吻合术组)=13.432、7.628,P均=0.000)。Duhamel术组患者术后3个月、1年、2年排便次数明显少于吻合术组(t=2.238、2.620、2.471,p=0.033、0.014、0.020)。结论改良Duhamel术与回肠乙状结肠吻合术对慢传输型便秘均有良好的治疗效果,而改良Duhamel术能减少患者术后腹泻次数,手术效果优于回肠乙状结肠吻合术。Objective To investigate the effect of modified Duhamel procedure and ileal sigmoid anastomosis（ISA）on slow transit constipation and the effect on postoperative diarrhea. Methods The subjects were from the clinical data of 35 cases of slow transit constipation（STC） admitted to surgery department of the PLA 202 Hospital from January 2010 to December 2015. According to the different surgical method,the patients were divided into two groups. Group modified Duhamel procedure（Duhamel group） was 21 cases and group ileal sigmoid anastomosis（Anastomosis group） was 14 cases. The duration of operation, blood loss, postoperative intestinal fistula, postoperative intestinal obstruction, WCS score, GIQLI score and other data were analyzed. The duration of operation, blood loss, postoperative intestinal fistula, postoperative intestinal obstruction, WCS score, GIQLI score and other data were analyzed. Repeated measurements of variance were used to analyze the frequency of defecation in 2 groups of patients at before, 3 months, 6 months, 1 year and 2 years after operation. Results There was no significant difference between 2 groups in gender, age, the duration of constipation, the time of resuming flow of fluid after operation, postoperative drainage tube time, length of stay after surgery, postoperative intestinal fistula, incisional infection and postoperative intestinal obstruction（P〉0.05）. The operation duration and intraoperative blood loss in Duhamel group were greater than those in Anastomosis group, the difference was statistically significant（t = 2. 221, t =2. 332,P =0.033, P = 0.026）. The 2 types of operation can obviously improve the constipation of patients. There was significant difference between the 2 groups in WCS score and GIQLI score before and after operation（t =16.861, t =7.108;t =13.432, t =7.628,all P =0.000）. The number of defecation in Duhamel group was significantly less than that in Anastomosis group after operation, the difference was statistically significant（t=2.238,

关 键 词：改良DUHAMEL术 结肠次全切除回肠乙状结肠吻合术 慢传输型便秘 排便次数 

分 类 号：R656.9[医药卫生—外科学]