【摘要】 目的评估结肠旷置术治疗老年慢传输型便秘(STC)的临床疗效。方法回顾性分析2010年5月至2017年12月天津市第三中心医院收治的60例老年STC患者的临床资料。所有患者均采用全结肠旷置+回直逆蠕动侧侧吻合术治疗,分析手术相关指标(手术时间、术中出血量、术后住院时间、术后首次排气时间及首次排便时间)、术后不同时间点(3、6、12个月)便秘症状缓解情况及术后(3、6、12个月)胃肠生活质量评分(GIQLI)、便秘患者生存质量评分(PAC-QOL)和Wexner便秘评分评价治疗效果。结果 60例老年STC患者均顺利完成全结肠旷置术,术中均未发生严重并发症;平均手术时间(65.37±3.56) min,平均术中出血量(20.45±1.60) mL,平均术后住院时间(9.62±1.58) d,术后首次肛门排气时间(3.25±1.02) d,首次排便时间(4.74±1.36) d;术后至出院期间观察无吻合口漏、小肠梗阻及心脑血管意外等并发症发生,无死亡病例。所有患者术后便秘症状均缓解,术后3个月排便次数(3.40±1.20)次/日,术后6个月排便次数(2.20±0.40)次/日,术后12个月排便次数(1.10±0.30)次/日,随着时间延长,随访患者的排便次数接近1次/日。术后3、6、12个月GIQLI评分较术前均升高,PAC-QOL及Wexner便秘评分较术前均降低,差异均有统计学意义(均P<0.05)。术后发生严重腹泻3例(5%),盲袢综合症14例(23.3%),所有患者无便秘复发情况。结论结肠旷置术治疗老年慢传输型便秘患者疗效确切,操作简单,手术创伤小,可改善患者生活质量,值得临床开展。更多还原

【Abstract】 Objectives To investigate the effect of colonic exclusion in treating elderly patients with slow transit constipation(STC). Methods This was a retrospective analysis of 60 elderly patients with STC treated at Tianjin Third Central Hospital between May 2010 and December 2017. All patients were treated with colonic exclusion and side-to-side anastomosis(rectum with the proximal end of ascending colon). Duration of surgery, intraoperative blood loss, postoperative hospitalization, time to first postoperative anal exhaust, time to first postoperative bowel movement, and relief of constipation(at 3, 6, and 12 months after surgery) were recorded. The following questionnaires were administered at 3, 6, and 12 months after surgery: Gastrointestinal Quality of Life Index(GIQLI), Patient Assessment of Constipation Quality of Life questionnaire(PAC-QOL), and Wexner Continence Grading Scale. Results The surgery was uneventful in all patients with no serious adverse events. Duration of surgery was(65.37±3.56) min, intraoperative blood loss was(20.45±1.60) mL; postoperative hospitalization was(9.62±1.58) days; time to first anal exhaust was(3.25±1.02) days; time to first bowel movement was(4.74±1.36) days. No anastomotic leakage, small intestinal obstruction, cardio-and cerebrovascular event, or death was observed. Relief of constipation was seen in all patients. The number of bowel movements at 3 months after surgery was(3.40±1.20) times/day. The corresponding number at 6 and 12 months after surgery were(2.20±0.40) and(1.10±0.30) time/day, respectively. The defecation frequency of the follow-up patients was close to one time per day overtime. GIQLI increased significantly after surgery, PAC-QOL and Wexner score decreased significantly at 3, 6,and 12 months after surgery(P<0.05). Diarrhea was observed in 3(5%) patients and blind-loop syndrome in 14(23.3%) patients.No recurrence was reported. Conclusion Colonic exclusion is effective in treating elderly patients with STC. It is a simple procedure with minimal invasiveness and an increase in patients’ quality of life.更多还原