• 中國醫(yī)科大學(xué)附屬盛京醫(yī)院結(jié)直腸、肛門病外科(遼寧沈陽 110004);

目的  總結(jié)腹腔鏡輔助結(jié)腸次全切除聯(lián)合改良Duhamel術(shù)治療重度功能性便秘(SFC)的近期療效、手術(shù)并發(fā)癥及相關(guān)手術(shù)經(jīng)驗。
方法  回顧性分析2010年3月至2011年8月期間我科行腹腔鏡輔助結(jié)腸次全切除聯(lián)合改良Duhamel術(shù)治療的15例經(jīng)保守治療無效的SFC患者的臨床資料,比較SFC患者術(shù)前1d及術(shù)后1個月的胃腸生活質(zhì)量評分及便秘癥狀改善情況。
結(jié)果  15例SFC患者手術(shù)均獲得成功,手術(shù)時間為(247.33±55.10) min,術(shù)中出血量為(107.33±45.59) ml,手術(shù)切口長度為(8.40±2.41) cm,術(shù)后離床活動時間為(2.27±1.28) d,術(shù)后肛門排氣時間為(2.60±1.89) d,術(shù)后排便時間為(2.87±2.50) d,術(shù)后進食時間為(3.07±1.16) d,術(shù)后住院時間為(12.64±2.37) d。術(shù)后3~4d出現(xiàn)腹瀉患者10例,藥物控制良好;術(shù)后8d出現(xiàn)腸梗阻1例,經(jīng)保守治療痊愈;術(shù)后9d出現(xiàn)吻合口漏并發(fā)深部感染患者1例,經(jīng)保守治療痊愈。術(shù)后1個月胃腸生活質(zhì)量總評分較術(shù)前明顯改善〔(121.80±4.72)分比(90.80±7.24)分,P=0.000〕,便秘癥狀改善度為(0.81±0.56)%。
結(jié)論  從本組有限的病例資料看,腹腔鏡輔助結(jié)腸次全切除聯(lián)合改良Duhamel手術(shù)治療SFC近期療效良好、安全性確切,具有出血少、創(chuàng)傷小、術(shù)后恢復(fù)快的特點。

引用本文: 孫威,陳愛山,閆兆鵬,曹獻馗,殷紅專,尹劍橋,蘇琪,劉寶林. 腹腔鏡輔助下結(jié)腸次全切除聯(lián)合改良Duhamel手術(shù)治療重度功能性便秘. 中國普外基礎(chǔ)與臨床雜志, 2013, 20(2): 169-173. doi: 復(fù)制

1. 郭曉峰, 柯美云, 潘國宗, 等. 北京地區(qū)成人慢性便秘整群、分層、隨機流行病學(xué)調(diào)查及其相關(guān)因素分析[J]. 中華消化雜志, 2002, 22(10):637-638.
2. 于普林, 李增金, 鄭宏, 等. 老年人便秘流行病學(xué)特點的初步分析[J]. 中華老年醫(yī)學(xué)雜志, 2001, 20(2):132-134.
3. 姜軍, 李寧, 朱維銘, 等. 手助腹腔鏡結(jié)腸次全切除聯(lián)合改良Duhamel術(shù)治療重度功能性便秘[J]. 醫(yī)學(xué)研究生學(xué)報, 2007, 20(9):931-933, 937.
4. Peppas G, Alexiou VG, Mourtzoukou E, et al. Epidemiology of constipation in Europe and Oceania:a systematic review[J]. BMC Gastroenterol, 2008, 8:5.
5. B?achut K, Bednarz W, Paradowski L. Surgical treatment of cons-tipation[J]. Rocz Akad Med Bialymst, 2004, 49:47-52.
6. 孟榮貴, 郝立強, 傅傳剛, 等. 結(jié)腸慢傳輸型便秘的診斷和治療[J]. 中國實用外科雜志, 2002, 22(12):719-721.
7. Lundin E, Karlbom U, Westlin JE, et al. Scintigraphic assessment of slow transit constipation with special reference to right-or left-sided colonic delay[J]. Colorectal Dis, 2004, 6(6):499-505.
8. Scarpa M, Barollo M, Keighley MR. Ileostomy for constipation:long-term postoperative outcome[J]. Colorectal Dis, 2005, 7(3):224-227.
9. 李紅巖, 張燕, 趙發(fā). 改良結(jié)腸曠置術(shù)治療老年頑固性便秘[J]. 中華胃腸外科雜志, 2010, 13(7):543.
10. Longstreth GF, Thompson W G, Chey W D, et al. Functional boweldisorders[J]. Gastroenterology, 2006, 130(5):1480-1491.
11. 陶琦, 錢群, 江從慶, 等. 胃腸道生存質(zhì)量指數(shù)在慢傳輸型便秘患者手術(shù)療效評估中的應(yīng)用[J]. 中華胃腸外科雜志, 2008, 11(5):509-511.
12. Eypasch E, Williams JI, Wood-Dauphinee S, et a1. Gastrointestinal quality of life index:development, validation and applicationof a new instrument[J]. Br J Surg, 1995, 82:216-222.
13. 中華醫(yī)學(xué)會外科學(xué)分會肛腸外科學(xué)組. 便秘癥狀及療效評估[J]. 中華胃腸外科雜志, 2005, 8(4):355.
14. Bassotti G, Villanacci V, Maurer CA, et al. The role of glial cells and apoptosis of enteric neurones in the neuropathology of intractable slow transit constipation[J]. Gut, 2006, 55(1):41-46.
15. Tomita R, Fujisaki S, Ikeda T, et al. Role of nitric oxide in the colon of patients with slow-transit constipation[J]. Dis Colon Rectum, 2002, 45(5):593-600.
16. Mitolo-Chieppa D, Mansi G, Rinaldi R, et al. Cholinergic stimulation and nonadrenergic, noncholinergic relaxation of human colonic circular muscle in idiopathic chronic constipation[J]. DigDis Sci, 1998, 43(12):2719-2726.
17. Costagliola A, Russo D, Izzo AA, et al. Distribution and activityof fatty acid amide hydralase (FAAH) in the gastrointestinal neuronsof mouse[J]. Anat Histol Embryol, 2005, 34(s1):13.
18. Lee JI, Park H, Kamm MA, et al. Decreased density of interstitial cells of Cajal and neuronal cells in patients with slow-transit constipation and acquired megacolon[J]. J Gastroenterol Hepatol, 2005, 20(8):1292-1298.
19. Madrid AM, Defilippi C. Disturbances of small intestinal motility in patients with chronic constipation[J]. Rev Med Chil, 2006, 134(2):181-186.
20. Wang KS, Ma T, Filiz F, et al. Colon water transport in transgenic mice lacking aquaporin-4 water channels[J]. Am J PhysiolGastrointest Liver Physiol, 2000, 279(2):G463-G470.
21. Rotholtz NA, Steven DW. Surgical treatment of constipation and fecal incontinence[J]. Gastroenterol Clin North Am, 2001, 30(1):131-166.
22. Tong WD, Liu BH, Zhang SB, et al. Abdominal colectomy as a treatment of obstinate slow transit constipation:clinical results and aetiological analysis[J]. Formos J Surg, 2003, 36:112-119.
23. Jiang CQ, Qian Q, Liu ZS, et al. Subtotal colectomy with antiperistaltic cecoproctostomy for selected patients with slow transit constipation-from Chinese report[J]. Int J Colorectal Dis, 2008, 23(12):1251-1256.
24. Conzo G, Stanzione F, Celsi S, et al. Videolaparo-assisted subt-otal colectomy with cecorectal anastomosis in the treatment of chro-nic slow transit constipation[J]. G Chir, 2011, 31(11-12):487-490.
25. 劉寶華. 頑固性便秘的外科治療[J]. 中國實用外科雜志, 2007, 27(6):492-494.
26. Fitzharris GP, Garcia-Aguilar J, Parker SC, et al. Quality of life after subtotal colectomy for slow-transit constipation:both quality and quantity count[J]. Dis Colon Rectum, 2003, 46(4):433-440.
27. Iannelli A, Fabiani P, Mouiel J, et al. Laparoscopic subtotal colectomy with cecorectal anastomosis for slow-transit constipation[J]. Surg Endosc, 2006, 20(1):171-173.
28. Aldulaymi BH, Rasmussen O?, Christiansen J. Long-term resultsof subtotal colectomy for severe slow-transit constipation in patientswith normal rectal function[J]. Colorectal Dis, 2001, 3(6):392-395.
29. El-Tawil AM. Reasons for creation of permanent ileostomy for the management of idiopathic chronic constipation[J]. J Gastroenterol Hepatol, 2004, 19(8):844-846.
  1. 1. 郭曉峰, 柯美云, 潘國宗, 等. 北京地區(qū)成人慢性便秘整群、分層、隨機流行病學(xué)調(diào)查及其相關(guān)因素分析[J]. 中華消化雜志, 2002, 22(10):637-638.
  2. 2. 于普林, 李增金, 鄭宏, 等. 老年人便秘流行病學(xué)特點的初步分析[J]. 中華老年醫(yī)學(xué)雜志, 2001, 20(2):132-134.
  3. 3. 姜軍, 李寧, 朱維銘, 等. 手助腹腔鏡結(jié)腸次全切除聯(lián)合改良Duhamel術(shù)治療重度功能性便秘[J]. 醫(yī)學(xué)研究生學(xué)報, 2007, 20(9):931-933, 937.
  4. 4. Peppas G, Alexiou VG, Mourtzoukou E, et al. Epidemiology of constipation in Europe and Oceania:a systematic review[J]. BMC Gastroenterol, 2008, 8:5.
  5. 5. B?achut K, Bednarz W, Paradowski L. Surgical treatment of cons-tipation[J]. Rocz Akad Med Bialymst, 2004, 49:47-52.
  6. 6. 孟榮貴, 郝立強, 傅傳剛, 等. 結(jié)腸慢傳輸型便秘的診斷和治療[J]. 中國實用外科雜志, 2002, 22(12):719-721.
  7. 7. Lundin E, Karlbom U, Westlin JE, et al. Scintigraphic assessment of slow transit constipation with special reference to right-or left-sided colonic delay[J]. Colorectal Dis, 2004, 6(6):499-505.
  8. 8. Scarpa M, Barollo M, Keighley MR. Ileostomy for constipation:long-term postoperative outcome[J]. Colorectal Dis, 2005, 7(3):224-227.
  9. 9. 李紅巖, 張燕, 趙發(fā). 改良結(jié)腸曠置術(shù)治療老年頑固性便秘[J]. 中華胃腸外科雜志, 2010, 13(7):543.
  10. 10. Longstreth GF, Thompson W G, Chey W D, et al. Functional boweldisorders[J]. Gastroenterology, 2006, 130(5):1480-1491.
  11. 11. 陶琦, 錢群, 江從慶, 等. 胃腸道生存質(zhì)量指數(shù)在慢傳輸型便秘患者手術(shù)療效評估中的應(yīng)用[J]. 中華胃腸外科雜志, 2008, 11(5):509-511.
  12. 12. Eypasch E, Williams JI, Wood-Dauphinee S, et a1. Gastrointestinal quality of life index:development, validation and applicationof a new instrument[J]. Br J Surg, 1995, 82:216-222.
  13. 13. 中華醫(yī)學(xué)會外科學(xué)分會肛腸外科學(xué)組. 便秘癥狀及療效評估[J]. 中華胃腸外科雜志, 2005, 8(4):355.
  14. 14. Bassotti G, Villanacci V, Maurer CA, et al. The role of glial cells and apoptosis of enteric neurones in the neuropathology of intractable slow transit constipation[J]. Gut, 2006, 55(1):41-46.
  15. 15. Tomita R, Fujisaki S, Ikeda T, et al. Role of nitric oxide in the colon of patients with slow-transit constipation[J]. Dis Colon Rectum, 2002, 45(5):593-600.
  16. 16. Mitolo-Chieppa D, Mansi G, Rinaldi R, et al. Cholinergic stimulation and nonadrenergic, noncholinergic relaxation of human colonic circular muscle in idiopathic chronic constipation[J]. DigDis Sci, 1998, 43(12):2719-2726.
  17. 17. Costagliola A, Russo D, Izzo AA, et al. Distribution and activityof fatty acid amide hydralase (FAAH) in the gastrointestinal neuronsof mouse[J]. Anat Histol Embryol, 2005, 34(s1):13.
  18. 18. Lee JI, Park H, Kamm MA, et al. Decreased density of interstitial cells of Cajal and neuronal cells in patients with slow-transit constipation and acquired megacolon[J]. J Gastroenterol Hepatol, 2005, 20(8):1292-1298.
  19. 19. Madrid AM, Defilippi C. Disturbances of small intestinal motility in patients with chronic constipation[J]. Rev Med Chil, 2006, 134(2):181-186.
  20. 20. Wang KS, Ma T, Filiz F, et al. Colon water transport in transgenic mice lacking aquaporin-4 water channels[J]. Am J PhysiolGastrointest Liver Physiol, 2000, 279(2):G463-G470.
  21. 21. Rotholtz NA, Steven DW. Surgical treatment of constipation and fecal incontinence[J]. Gastroenterol Clin North Am, 2001, 30(1):131-166.
  22. 22. Tong WD, Liu BH, Zhang SB, et al. Abdominal colectomy as a treatment of obstinate slow transit constipation:clinical results and aetiological analysis[J]. Formos J Surg, 2003, 36:112-119.
  23. 23. Jiang CQ, Qian Q, Liu ZS, et al. Subtotal colectomy with antiperistaltic cecoproctostomy for selected patients with slow transit constipation-from Chinese report[J]. Int J Colorectal Dis, 2008, 23(12):1251-1256.
  24. 24. Conzo G, Stanzione F, Celsi S, et al. Videolaparo-assisted subt-otal colectomy with cecorectal anastomosis in the treatment of chro-nic slow transit constipation[J]. G Chir, 2011, 31(11-12):487-490.
  25. 25. 劉寶華. 頑固性便秘的外科治療[J]. 中國實用外科雜志, 2007, 27(6):492-494.
  26. 26. Fitzharris GP, Garcia-Aguilar J, Parker SC, et al. Quality of life after subtotal colectomy for slow-transit constipation:both quality and quantity count[J]. Dis Colon Rectum, 2003, 46(4):433-440.
  27. 27. Iannelli A, Fabiani P, Mouiel J, et al. Laparoscopic subtotal colectomy with cecorectal anastomosis for slow-transit constipation[J]. Surg Endosc, 2006, 20(1):171-173.
  28. 28. Aldulaymi BH, Rasmussen O?, Christiansen J. Long-term resultsof subtotal colectomy for severe slow-transit constipation in patientswith normal rectal function[J]. Colorectal Dis, 2001, 3(6):392-395.
  29. 29. El-Tawil AM. Reasons for creation of permanent ileostomy for the management of idiopathic chronic constipation[J]. J Gastroenterol Hepatol, 2004, 19(8):844-846.
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