慢传输型便秘的手术方式选择——全结肠切除和次全结肠切除  

Surgical treatment for slow transit constipation:total colectomy and subtotal colectomy

作　　者：郭满 童卫东 Guo Man;Tong Weidong(Department of General Surgery,the Army Medical Center(Daping Hospital),Chongqing 400042,China)

机构地区：[1]陆军军医大学大坪医院(陆军特色医学中心)普通外科,重庆400042

出　　处：《中华胃肠外科杂志》2024年第12期1248-1253,共6页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金(82370547);重庆市自然科学基金重点项目(CSTB2023NSCQZDJ0012)。

摘　　要：尽管针对慢传输型便秘(STC)的手术治疗已经有百年历史,但有关其手术方式的选择仍然存在争议。特别是目前国际上应用最多的两种术式:全结肠切除回肠直肠吻合术和次全结肠切除术。次全结肠切除后有多种吻合方式,包括回肠乙状结肠吻合和盲肠直肠吻合等;盲肠直肠吻合又分为顺蠕动与逆蠕动吻合两种方式。一般认为,全结肠切除术疗效确切,但术后腹泻表现更重;而次全结肠切除术可能减轻术后腹泻,但潜在增加便秘复发率的风险。有关上述手术方式的研究,绝大多数为回顾性小样本研究,证据质量不高。这也是当前临床上缺乏STC金标准术式的原因之一。本文综合近10年来有关STC手术治疗的研究文献,结合笔者团队33年便秘外科诊治经验,对顽固性STC手术方式选择进行探讨。Although the surgical treatment of slow transit constipation(STC)has been around for over a century,the choice of surgical method is still controversial.Specifically,the two most widely used operations in the world are total colectomy ileorectostomy(TC-IRA)and subtotal colectomy.Subtotal colectomy offers many methods for anastomosis,including ileocecal and cecorectal anastomoses and so on.Cecorectal anastomosis can be divided into two types:isoperistaltic anastomosis and antiperistaltic anastomosis.It is generally believed that total colectomy provides definitive effects but results in more severe postoperative diarrhea,while subtotal colectomy may reduce postoperative diarrhea but potentially increase the risk of constipation recurrence.Most studies of these surgical methods are retrospective small-sample studies with low-quality evidence.This is also one of the reasons for the lack of STC gold standard surgery in clinical practice.This paper discusses the selection of surgical methods for intractable slow transit constipation(STC)based on a review of literature published within the past 10 years,as well as our team's extensive 33-year experience in diagnosing and treating constipation surgically.

关 键 词：便秘 慢传输型 结肠切除术 治疗 手术 

分 类 号：R656.9[医药卫生—外科学]