腹腔镜结肠次全切除术治疗成人巨结肠的临床疗效  

Clinical efficacy of laparoscopic subtotal colectomy in adult megacolon

作　　者：王启飞 阚明韵 成汇[1] 邵明月 江志伟 龚冠闻 WANG Qifei;KAN Mingyun;CHENG Hui;SHAO Mingyue;JIANG Zhiwei;GONG Guanwen(Department of General Surgery,Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing,Jiangsu 210029,China)

机构地区：[1]南京中医药大学附属医院普外科,江苏南京210029

出　　处：《中国临床研究》2023年第8期1130-1133,共4页Chinese Journal of Clinical Research

摘　　要：目的探讨对成人巨结肠患者行腹腔镜结肠次全切除+回肠袢式造口术的临床疗效及安全性。方法回顾性分析2016年10月至2020年10月江苏省中医院接受腹腔镜结肠次全切除+回肠袢式造口术治疗的22例成人巨结肠患者的临床资料,所有患者均于术前经CT、钡灌肠、肛门直肠测压及术后病理检查等确诊巨结肠。对比患者术前、术后的腹痛腹胀症状、胃肠道生活质量指数(GIQLI)、Wexner便秘评分和手术并发症情况。结果22例患者术前腹胀症状发生率为100%,术后均改善,术后12个月腹胀发生率为4.5%(1/22)。术后第6、12个月Wexner便秘评分分别为(6.27±2.16)分、(4.77±1.11)分,优于术前的(20.41±2.48)分;术后第6、12个月GIQLI分别为(104.05±12.09)分、(102.23±8.20)分,优于术前的(68.64±6.04)分,差异有统计学意义(P<0.05)。术后发生手术部位感染1例(4.5%),吻合口瘘1例(4.5%),腹腔出血1例(4.5%)。结论腹腔镜结肠次全切除+回肠袢式造口术是治疗成人巨结肠安全且有效的术式。Objective To observe the clinical efficacy and safety of laparoscopic subtotal colectomy+loop colostomy in adult patients with megacolon.Methods Retrospective analysis was performed on the clinical data of 22 adult megacolon patients treated by laparoscopic subtotal colectomy+loop colostomy in Affiliated Hospital of Nanjing University of Chinese Medicine from October 2016 to October 2020.All patients underwent preoperative CT,barium enema,anorectal manometry,and postoperative pathological examination to diagnose megacolon.The symptoms of abdominal pain and abdominal distension,gastrointestinal quality of life score index(GIQLI),Wexner constipation score and surgical complications were analyzed and compared before and after surgery.Results The incidence of preoperative abdominal distension symptoms of 22 patients was 100%,and all improved after surgery.The incidence of abdominal distension at 12 months after surgery was 4.5%(1/22).The Wexner constipation scores at the 6th and 12th months after surgery were 6.27±2.16 and 4.77±1.11,respectively,significantly better than the preoperative score(20.41±2.48,P<0.05).The GIQLI at the 6th and 12th months after surgery were 104.05±12.09 and 102.23±8.20,respectively,significantly better than the preoperative score(68.64±6.04,P<0.05).The postoperative complications included 1 infection at the operation site(4.5%),1 case of anastomotic fistula(4.5%),1 case of abdominal bleeding(4.5%).Conclusion Laparoscopic subtotal colectomy+loop colostomy is a safe and effective operation for the treatment of adult megacolon,which is worthy of further exploration and application.

关 键 词：巨结肠 成人 腹腔镜 结肠次全切除术 预防性造口 腹胀 回肠袢式造口术 

分 类 号：R574.62[医药卫生—消化系统]