【摘要】 目的比较腹腔镜下不同术式治疗混合型顽固性便秘的手术疗效及术后恢复情况。方法选择我院2011年1月至2014年12月收治83例混合型顽固性便秘患者作为研究对象,随机分为A组(n=42)与B组(n=41)。A组行腹腔镜下金陵术,B组行腹腔镜下全结肠切除术,比较两组围手术期指标(手术时间、排气时间及住院时间)、安全性(并发症发生率)、远期疗效,应用GIQLI(胃肠生活质量指数)、WCS(Wexner便秘评分)及营养状况(白蛋白、前白蛋白)进行评价。结果两组手术时间、排气时间差异无统计学意义(P>0.05),A组住院时间短于B组,差异有统计学意义(P<0.05)。A组术后总并发症发生率为23.8%(10/42),低于B组46.3%(19/41),差异有统计学意义(P<0.05)。两组术前GIQLI、WCS评分及营养状况的差异均无统计学意义(P>0.05),术后两组GIQLI、白蛋白、前白蛋白均先下降再升高,但A组术后3个月、6个月及12个月的GIQLI、白蛋白、前白蛋白均高于B组,差异有统计学意义(P<0.05),术后两组WCS评分逐渐降低,A组始终高于B组,差异有统计学意义(P<0.05)。结论腹腔镜下金陵术的应用有效重建盆底直肠结构,纠正肠黏膜脱垂及套叠,消除耻骨直肠肌对排便影响,不仅利于患者更快出院,同时促进患者术后营养状况及生活质量的改善,并发症也更少,值得推广。更多还原

【Abstract】 Objective To compare the curative effects and postoperative recovery of different laparoscopic surgical treatments in the treatment of mixed type intractable constipation. Methods Eighty-threepatients with mixed type intractable constipation treated in our hospital from January 2011 to December 2014 were selectedas study subjects and were randomly assigned to group A(n =42) and group B(n =41). Patients in group A underwent laparoscopic Jinling procedure and patients ingroup B underwent laparoscopic total colectomy. The perioperative indexes(operative time, exhaust time and hospitalization time), safety(incidence of complications) and long-term curative effects in the two groups were compared. GIQLI(Gastrointestinal Quality of Life Index), WCS(Wexner Constipation Score) and nutritional status(albumin, prealbumin) were evaluated. Results Differences in operative time and exhaust time between the two groups were not statistically significant(P >0.05). Length of hospital stayin group A was shorter than that in group B(P <0.05). Incidence of postoperative complications in group A [23.8%(10 / 42)] was lower than that in group B [46.3%(19 / 41)](P <0.05), which indicated better safety in group A.Differences in GIQLI and WCS scores and nutritional status between the two groups before operation were not statistically significant(P >0.05). GIQLI, albumin and prealbumin of the two groups decreased but then increased after operation.GIQLI, albumin and prealbuminat different time points after operation in group A were significantly higher than those in group B(P <0.05). The WCS scores of the two groups decreased gradually after operation but scores in group A were higher than thosein group B(P <0.05). Conclusion Laparoscopic Jinling procedure can effectively reconstruct the pelvic floor rectalstructures, correct intestinal mucosal prolapse and intussusception, and eliminate the effect of puborectalis on defecation. It not only resultsin earlier discharge of patients but also improvepostoperative nutritional status and quality of life with lower complication rate. It holds value for clinical use.更多还原