中国普外基础与临床杂志

中国普外基础与临床杂志

结肠次全切除回肠乙状结肠吻合术治疗慢传输型便秘的临床疗效

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目的 探讨全结肠切除回肠直肠吻合术(ileorectal anastomosis,IRA)和结肠次全切除回肠乙状结肠吻合术(ileosigmoidal anastomosis,ISA)治疗慢传输型便秘的疗效。 方法 回顾性分析 2008 年 1 月至 2015 年 1 月期间收治的 45 例慢传输型便秘患者的临床资料,按采取的手术方式分为 IRA 组和 ISA 组,比较 2 组患者的手术时间、术中出血量、术后住院时间、止泻剂应用率及并发症发生情况,术后随访 3、6、12 及 24 个月时对 2 组患者的排便次数、Wexner 便秘评分、肛门失禁评分、胃肠生活质量指数评分、腹痛频率评分和腹胀频率评分进行比较。 结果 ① IRA 组 23 例,ISA 组 22 例,2 组患者的基线资料如性别、年龄、便秘时间、胃肠传输试验阳性滞留的结肠段等基线资料比较差异均无统计学意义(P>0.05)。② 2 组患者的手术时间、术中出血量和术后并发症发生率比较差异均无统计学意义(P>0.05),但是与 IRA 组比较,ISA 组的术后住院时间明显缩短、止泻药使用率相对较低(P<0.05)。③ 所有患者均随访 2 年,术后排便情况及生活质量均较术前明显改善,在术后第 3、6、12 个月时 IRA 组的排便次数均明显高于 ISA 组(P<0.05),至术后第 24 个月时 2 组基本接近正常;Wexner 便秘评分、肛门失禁评分、胃肠生活质量指数评分、腹痛频率评分及腹胀频率评分术后不同时相 2 组间比较差异均无统计学意义(P>0.05)。 结论 结肠次全切除后 ISA 治疗慢传输型便秘较全结肠切除后 IRA 均安全及有效,可根据患者具体病情个体化选择,在严格把握指征的前提下,ISA 术优势更明显。

Objective To investigate efficacy of total colectomy-ileorectal anastomosis (IRA) and subtotal colectomy-ileosigmoidal anastomosis (ISA) in treatment of patients with slow transit constipation (STC). Methods The clinical data of 45 patients with STC from January 2008 to January 2015 underwent operation were analyzed retrospectively. These patients were divided into an IRA group and ISA group according to the operation method, there were 23 cases in the IRA group and 22 cases in the ISA group. The operative time, operation blood loss, postoperative hospitalization, use of antidiarrheal agents, and complications rate in both groups were compared. All patients were followed up at the 3th, 6th, 12th, and 24th month after the operation, the defecation frequency, Wexner continence score, Wexner anal incontinence score, gastrointestinal quality of life index (GIQLI) score, abdominal pain frequency score, and abdominal distension frequency score in two groups were evaluated. Results There were no significantly statistical differences between the two groups in the operation time, operation blood loss, and postoperative complications rate (P>0.05). In the perioperative period, compared with the IRA group, the ISA group had a shorter postoperative hospitalization and a relatively lower proportion of antidiarrheal drugs, the differences were statistically significant between the two groups (P<0.05). On the postoperative 3th, 6th, and 12th months, the frequency of defecation in the IRA group was significantly higher than that in the ISA group (P<0.05); The Wexner continence score, Wexner anal incontinence score, gastrointestinal quality of life index score, abdominal pain frequency score, and abdominal distension frequency score had no statistically differences between the two groups (P>0.05). Conclusions ISA and IRA are safe and effective in treatment of STC, it might be selected according to patient’s conditions. On premise of strictly grasping indications, ISA has more obvious advantages.

关键词: 慢传输型便秘; 结肠次全切除术; 回肠乙状结肠吻合术; 回肠直肠吻合术

Key words: slow transit constipation; subtotal colectomy; ileosigmoidal anastomosis; ileorectal anastomosis

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