67例老年顽固性慢传输型便秘行全结肠旷置术后的疗效观察  

Effect of ileosigmoidostomy shunting surgery in treating refractory slow transit constipation:A descriptive analysis of 67 older patients

作　　者：陈钰[1] 杜静虎 田葵[1] 陶正贵[1] Chen Yu;Du Jinghu;Tian Kui;Tao Zhenggui(Department of General Surgery,Xiangyang Central Hospital,Xiangyang 441021,Hubei,China)

机构地区：[1]襄阳市中心医院普外科,湖北襄阳441021

出　　处：《结直肠肛门外科》2019年第2期221-225,共5页Journal of Colorectal & Anal Surgery

摘　　要：目的分析67例行全结肠旷置术治疗的老年顽固性慢传输型便秘患者的临床资料,探讨该术式的临床疗效。方法收集2010年6月至2017年7月襄阳市中心医院收治的67例行全结肠旷置术治疗的老年顽固性慢传输型便秘患者的临床资料,分析患者手术相关指标、术后并发症发生情况及手术前后排便情况;对比患者术前、术后6个月、12个月Wexner便秘评分及胃肠生活质量指数评分。结果所有患者均顺利完成手术,术后均通过电话及门诊随访,随访时间为12 (6,29)个月,无一例出现术后严重并发症及死亡。手术时间为43～63 min,平均手术时间为54 (52,58) min;术中出血量为22～31 mL,平均术中出血量为29 (28,30) mL;术后第一次排便时间为3～9 d,平均术后第一次排便时间为6 (5,7) d;住院时间为9～16 d,平均住院时间为12 (11,14) d。67例患者中,2例术后出现切口感染;14例出现结肠旷置综合征,其中12例行灌肠、口服肠道益生菌及肠道动力药物后明显好转,仅2例严重病例因反复恶心、腹胀、腹痛等,行回肠末端造口术。患者术前大便干结,排便费力,3～7d排便1次;患者术后均排便良好,术后1个月排便次数为(4.00±1.00)次/天,术后6个月排便次数为(2.50±0.50)次/天,术后12个月排便次数为(1.20±0.40)次/天。随着随访时间延长,患者排便次数缓慢恢复至1次/天左右。术后6个月及术后12个月Wexner便秘评分均低于术前(均P <0.05);术前胃肠生活质量指数评分低于术后6个月、术后12个月(均P <0.05)。结论全结肠旷置术是治疗老年顽固性慢传输型便秘的一种有效术式,但远期易发生结肠旷置综合征等,需临床随访观察。Objectives To perform descriptive analysis of 67 older patients with refractory slow transit constipation who received ileosigmoidostomy shunting surgery and to investigate the effect of this surgery.Methods This was a retrospective analysis of clinical data of 67 older patients with refractory slow transit constipation who received ileosigmoidostomy shunting surgery in Xiangyang Central Hospital between June 2010 and July 2017.Descriptive analyses include indices related to surgery,postoperative complications and bowel movement before and after surgery.Wexner constipation score and Gastrointestinal Quality of Life Index(GQLI)before surgery,6 months,and 12 months after surgery were compared.Results All surgery were uneventful.Postoperative follow-ups were conducted through telephone or outpatient clinic visit.Median follow-up duration was 12(6,29)months.There was no severe postoperative complication or death.Duration of surgery ranged from 43 to 63 mins,with median of 54(52,58)mins.Intraoperative blood loss ranged from 22 to 31 mL,with median loss of 29(28,30)mL.Time to first postoperative bowel movement ranged from 3 to 9 days,with median of 6(5,7)days.Duration of hospitalization ranged from 9 to 16 days,with median of 12(11,14)days.Among the 67 patients,2 had wound infection and 14 short-bowel syndrome,12 of which had symptoms alleviated after enema and oral use of probiotics and motility drugs.Only 2 patients had severe pain and distention and symptoms were relieved after ileum ostomy.Frequency of bowel movement was once per 3 to 7 days before surgery.Frequency was(4.00±1.00)per day 1 month after surgery,(2.50±0.50)per day 6 months after surgery,and(1.20±0.40)per day 12 months after surgery.Frequency returned to once per day gradually with follow-up.Wexner constipation score was significantly lower 6 and 12 months after than before surgery(P<0.05).GQLI was significantly higher 6 and 12 months after than before surgery(P<0.05).Conclusions Ileosigmoidostomy shunting surgery is an effective treatment for older

关 键 词：老年慢传输型便秘 全结肠旷置术 结肠旷置综合征 Wexner便秘评分 胃肠生活质量指数 

分 类 号：R442.2[医药卫生—诊断学]