摘要
目的比较保留回盲部的腹腔镜下结肠次全切除、顺蠕动升结肠直肠吻合术与逆蠕动盲直肠吻合术治疗重度慢传输型便秘的临床疗效及术后患者的生活质量。方法回顾性分析2016年1月至2021年10月树兰(杭州)医院连续收治并行手术治疗的42例重度慢传输型便秘患者的临床资料,均行保留回盲部的腹腔镜下结肠次全切除术,其中25例采取升结肠与直肠的顺蠕动吻合,17例采取盲肠底与直肠的逆蠕动吻合。结果两组患者手术时间和住院时间差异均无统计学意义(t=-0.464,P=0.645;t=0.010,P=0.992);两组患者术后6个月和12个月Wexner便秘评分均显著降低,两组间差异均无统计学意义(t=-1.181,P=0.240;t=-1.717,P=0.090);两组患者术后6个月和12个月每日排便次数(t=0.179,P=0.860;t=0.545,P=0.590)和Bristol粪便性状评分(t=-0.316,P=0.75;t=0.447,P=0.66)差异均无统计学意义;术后6个月和12个月顺蠕动组患者胃肠生活质量指数评分均显著高于逆蠕动组(t=4.329,P<0.05;t=3.988,P<0.05),而腹痛评分均显著低于逆蠕动组(t=-4.386,P<0.05;t=-5.740,P<0.05)。结论对于重度慢传输型便秘患者,行保留回盲部的腹腔镜下结肠次全切除,无论是顺蠕动升结肠直肠吻合(回盲部自前向后翻转)还是逆蠕动盲肠直肠吻合均具有良好的手术安全性及近期和中期临床疗效;顺蠕动吻合术后较逆蠕动吻合术后具有更低的腹痛评分和更好的胃肠生活质量,应首先推荐,手术过程中应将回结肠系膜充分游离至系膜根并将回盲部自前向后翻转,可避免肠系膜血管扭转及小肠梗阻的发生。
Objective To compare the clinical efficacy of ileocecal-preserving laparoscopic subtotal colectomy,antegrade peristaltic ascending colorectal anastomosis with antiperistalsis cecorectal anastomosis in the treatment of severe slow transit constipation.Methods The clinical data of 42 patients with severe slow transit constipation undergoing surgery in Shulan(Hangzhou)Hospital from Jan 2016 to Oct 2021 were retrospectively analyzed.All 42 patients underwent ileocecal-preserving laparoscopic subtotal colectomy.Among them,25 patients underwent antegrade peristaltic anastomosis of ascending colon and rectum,17 patients underwent antiperistaltic anastomosis of cecum and rectum.Results There was no significant difference in the operation time and hospitalization time between the two groups(t=-0.464,P=0.645;t=0.010,P=0.992);Wexner constipation scores in both groups were significantly reduced at 6 and 12 months after surgery.There was no significant difference in the Wexner constipation scores(t=-1.181,P=0.240;t=-1.717,P=0.090),the number of bowel movenents per day(t=0.179,P=0.860;t=0.545,P=0.590)and stool shapes scores(t=-0.316,P=0.750;t=0.447,P=0.660)between the two groups at 6 and 12 months after surgery.Gastrointestinal quality of life index scores in the antegrade peristaltic anastomosis group were significantly higher than those in the antiperistalsis anastomosis group at 6 and 12 months after surgery(t=4.329,P<0.05;t=3.988,P<0.05),while abdominal pain scores were significantly lower than those in the antiperistalsis anastomosis group(t=-4.386,P<0.05;t=-5.740,P<0.05).Conclusions For patients with severe slow transit constipation,ileocecal-preserving laparoscopic subtotal colectomy has good surgical safety and near-to-medium-term clinical efficacy,whether it is antegrade peristaltic ascending colorectal anastomosis(the stump of the ascending colon is turned from front to back)or antiperistalsis cecorectal anastomosis.The antegrade peristaltic ascending colorectal anastomosis has lower abdominal pain score and better gastrointestinal quality of life than antiperistalsis cecorectal anastomosis,which should be recommended first.During the operation,the ileocolic mesentery should be fully separated to the root of mesentery and the ileocecal part should be turned from front to back to avoid the occurrence of mesenteric vascular torsion and small intestinal obstruction.
作者
朱潇逸
林建江
沈展
阮航
Zhu Xiaoyi;Lin Jianjiang;Shen Zhan;Ruan Hang(Department of Colorectal Surgery,Shulan(Hangzhou)Hospital,Hangzhou 310000,China;Department of Colorectal Surgery,the First Affiliated Hospital,School of Medicine,Zhejiang University,Hangzhou 310000,China)
出处
《中华普通外科杂志》
CSCD
北大核心
2024年第2期115-120,共6页
Chinese Journal of General Surgery
关键词
便秘
肠吻合术
外科
结肠切除术
腹腔镜
Constipation
Anastomosis,surgical
Colectomy
Laparoscopy
