Comparison of laparoscopic selective colectomy based on barium-strip examination and subtotal colectomy for adult slow-transit constipation  

基于钡条传输试验的腹腔镜选择性结肠切除与腹腔镜次全结肠切除治疗成人慢传输型便秘的比较

作　　者：Zhao Hui Zhong Shen Yang Yong Zhao Yuan Wang Wei Dong Yong Ling Ling Zhang Qiu Sheng Wang Xun Huang 

机构地区：[1]General Surgery Department,Peking University People’s Hospital,Beijing,P.R.China [2]Insitute of Laboratory Animal Science,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing,P.R.China

出　　处：《Gastroenterology Report》2019年第5期361-366,I0002,共7页胃肠病学报道（英文）

基　　金：This study was supported by the National Science Foundation of China[No.81700751];the Scientific Research Foundation for the Returned Overseas Chinese Scholars[No.2110000021].

摘　　要：Background:Surgical management of adult slow-transit constipation(ASTC)can be effective for patients with intractable symptoms.This study aimed to evaluate whether barium-strip examination and selective colectomy improved post-operative outcomes in ASTC patients in comparison with subtotal colectomy.Methods:A retrospective cohort study of 53 cases with refractory ASTC was conducted between June 2008 and June 2014.Patients were evaluated by the barium-strip technique,colonoscopy,defecography and anorectal manometry.Patients in the standard group underwent laparoscopic subtotal colectomy and patients in the laparoscopic selective colectomy(LSC)group underwent LSC at the precise location identified by barium strip.Spontaneous bowel movements,the Wexner Constipation Scale and the Gastrointestinal Quality of Life Index(GIQLI)were assessed post-operatively at 3,6,12 and 24 months.Results:A total of 49 patients were included in the analysis.The median follow-up was 37 months(range,26–60 months).The mean post-operative hospital stay was 12 days and similar between groups(P=0.071).The length of colon resection,operative time and intra-operative blood loss were reduced in the LSC group(all P<0.05).No major complications occurred.A similar number of patients(24 in the standard group and 25 in the LSC group)exhibited hypoganglionosis or aganglionosis in the colon-wall muscle layer(P=0.986).Although there were no significant differences in post-operative spontaneous bowel movements and the Wexner Constipation Scale between the two groups,the mean GIQLI of the LSC group was significantly higher at 3,6 and 24 months post-operatively(all P<0.05).Conclusions:LSC based on barium-strip examination is an appropriate modality for treating ASTC.背景:外科手术是缓解成人慢传输便秘(ASTC)顽固性症状的有效治疗手段。本研究旨在评估,与次全结肠切除术相比,基于钡条传输试验的选择性结肠切除术能否提高ASTC的手术疗效。方法:采用回顾性队列研究,研究对象为2008年6月至2014年6月间收治的53例顽固性ASTC患者。术前行钡条传输试验、结肠镜检查、排粪造影和肛门测压。将行腹腔镜次全结肠切除手术的患者归为常规手术组,将基于钡条传输试验精准定位病变从而行腹腔镜选择性结肠切除术的患者归入LSC组。分别于术后3、6、12和24个月,记录患者自主排便次数、Wexner便秘评分和胃肠生活质量评分(GIQLI)。结果:49例患者纳入研究,其中常规手术组24例,LSC组25例。中位随访时间37个月(26-60个月)。平均术后住院时间12天,两组间差异无统计学意义(P=0.071)。LSC组结肠切除长度、手术时间和术中出血量均显著缩短(均P<0.05)。术后未出现严重并发症。两组患者中结肠壁肌层神经节细胞减少或缺乏的患者比例相当(P=0.986)。尽管术后自主排便次数和Wexner便秘评分两组患者的差异均无统计学意义,但LSC组患者术后3、6和24个月时GIQLI均显著高于常规手术组(均P<0.05)。结论:基于钡条传输试验的LSC是ASTC一种有效的治疗模式。

关 键 词：slow-transit constipation laparoscopic selective colectomy laparoscopic subtotal colectomy barium strip quality of life 

分 类 号：R656.9[医药卫生—外科学]