腹腔镜次全结肠旷置造口盲直肠吻合术治疗老年慢传输型便秘的临床疗效观察  

Clinical observation of laparoscopic subtotal colostomy and ceco-rectal anastomosis in the treatment of senile slow transit constipation

作　　者：曹永丽 王思远 李宜璐 吕兵兵 张春旭 杨阳 张远耀 杨维维 张文丽 魏东 Cao Yongli;Wang Siyuan;Li Yilu;Lv Bingbing;Zhang Chunxu;Yang Yang;Zhang Yuanyao;Yang Weiwei;Zhang Wenli;Wei Dong(Institute of Anal-Colorectal Surgery,the 989th Hospital of the Joint Logistics Support Force of PLA,Luoyang 471031,China;Postgraduate Department,Xinxiang Medical University,Xinxiang 453003,China;Department of Anal-Colorectal Surgery,the 988th Hospital of The Joint Logistics Support Force of PLA,Zhengzhou 450000,China)

机构地区：[1]中国人民解放军联勤保障部队第九八九医院全军肛肠外科研究所,洛阳471031 [2]新乡医学院研究生处,453003 [3]中国人民解放军联勤保障部队第九八八医院普通外科,郑州450000

出　　处：《中华结直肠疾病电子杂志》2022年第5期392-398,共7页Chinese Journal of Colorectal Diseases(Electronic Edition)

基　　金：河南省医学科技攻关项目(No.2011030031)。

摘　　要：目的对比观察腹腔镜次全结肠旷置盲直肠吻合术和腹腔镜次全结肠旷置造口盲直肠吻合术治疗老年慢传输型便秘的临床疗效。方法采用回顾性队列研究的方法,收集中国人民解放军联勤保障部队第九八九医院全军肛肠外科研究所于2008年12月至2017年12月期间收治的年龄≥70岁的70例结肠慢传输型便秘患者的病例资料,其中34例采用腹腔镜次全结肠旷置盲直肠吻合术进行治疗(结肠旷置手术组),36例采用腹腔镜次全结肠旷置造口盲直肠吻合术治疗(结肠旷置造口组),对比两种手术方式的临床治疗效果及两组间各项评分量表。对比术后3个月、6个月、12个月每天排便次数(BM)和Wexner肛门失禁评分(WIS),以及术前和术后3个月、6个月、12个月、24个月Wexner便秘评分(WCS)、胃肠生活质量指数(GIQLI),腹胀评分(ABS)和0~10数字疼痛量表(NRS)。结果所有患者均顺利进行了腹腔镜手术,术后均未发生排便失禁。术后3个月、6个月、12个月结肠旷置造口组的BM和WIS均明显少于结肠旷置手术组,差异有统计学意义[(BM)F_(3)=8.075、F_(6)=4.254、F_(12)=15.617,(WIS)F_(3)=11.760、F_(6)=14.422、F_(12)=27.467;均P<0.05]。术后3个月、6个月、12个月、24个月结肠旷置造口组WCS和GIQLI改善明显优于结肠旷置手术组[(WCS)F_(3)=4.132、F_(6)=4.028、F_(12)=18.780、F_(24)=23.224,(GIQLI)F_(3)=75.194、F_(6)=44.631、F_(12)=52.238、F_(24)=89.949;均P<0.05]。术后3个月结肠旷置造口组的ABS与结肠旷置手术组比较差异无统计学意义(F=2.423,P>0.05);术后6个月、12个月、24个月结肠旷置造口组ABS改善明显优于结肠旷置手术组(F_(6)=20.846,F_(12)=54.045,F_(24)=85.039;均P<0.05)。术后3个月结肠旷置造口组的NRS与结肠旷置手术组比较差异无统计学意义(F=1.635,P>0.05),术后6个月、12个月、24个月结肠旷置造口组的NRS与结肠旷置手术组比较得到明显改善(F_(6)=4.057,F_(12)=33.661,F_(24)=36.421Objective To compare the clinical efficacy of laparoscopic subtotal colonic exclusion and ceco-rectal anastomosis and laparoscopic subtotal colostomy and ceco-rectal anastomosis in the treatment of senile slow transit constipation.Methods A retrospective cohort study was conducted to collect the data of 70 patients with colonic slow transit constipation aged≥70 years treated in the Institute of Anal-Colorectal Surgery of the 989th Hospital of the Joint Logistics Support Force of PLA from December 2008 to December 2017,including 34 cases treated with laparoscopic subtotal colonic exclusion and ceco-rectal anastomosis(colonic exclusion group),thirty-six cases treated with laparoscopic subtotal colostomy and ceco-rectal anastomosis(colostomy group).The clinical therapeutic effects of the two surgical methods and the scores between the two groups were compared.The number of daily bowel movements(BM)and Wexner fecal incontinence scale(WIS)at 3,6 and 12 months after operation,Wexner constipation grading score(WCS),gastrointestinal quality of life index(GIQLI),abdominal bloating score(ABS)and 0~10 numerical rating scale for pain intensity(NRS)at 3,6,12 and 24 months before and after operation were compared.Results All patients underwent laparoscopic surgery successfully,and no fecal incontinence occurred after operation.At 3,6 and 12 months after operation,the BM and WIS in the colostomy group were significantly lower than those in the colonic exclusion group[(BM)F_(3)=8.075,F_(6)=4.254,F_(12)=15.617,(WIS)F_(3)=11.760,F_(6)=14.422,F_(12)=27.467;P<0.05];At 3,6,12 and 24 months after operation,the improvement of WCS and GIQLI in the colostomy group was significantly better than that in the colonic exclusion group[(WCS)F_(3)=4.132,F_(6)=4.028,F_(12)=18.780,F_(24)=23.224,(GIQLI)F_(3)=75.194,F_(6)=44.631,F_(12)=52.238,F_(24)=89.949;P<0.05];There was no significant difference in ABS between the colostomy group and the colonic exclusion group 3 months after operation(F=2.423,P>0.05);At 6,12 and 24 months after operation,the

关 键 词：便秘 老年 慢传输型便秘 次全结肠旷置造口术 腹腔镜微创手术 临床疗效观察 

分 类 号：R574.6[医药卫生—消化系统]