探讨次全结肠切除联合改良Duhamel术、直肠前壁悬吊术和子宫圆韧带短缩术在改善混合型便秘的出口梗阻病理因素方面的临床应用价值。

回顾性收集了2011年2月至2013年2月在我院接受腹腔镜次全结肠切除联合改良Duhamel术、直肠前壁悬吊术和子宫圆韧带短缩术的15例女性患者的临床资料。术后对Hallbook肛门功能量表、Bristol大便形态评分、GIQLI胃肠生活质量评分、Wexner评分、排便满意度随访2年。

术后随访满2年达100%。15例平均年龄(44.1±13.2)岁，平均病程(15.7±9.9)年，均为经产妇，在慢传输基础上同时合并1种或多种出口梗阻病理因素。其中，8/15同时合并直肠前突（轻-中度）、直肠粘膜脱垂/套叠、子宫后倒和会阴下降。术后1月、3月、6月、1年和2年，排便次数分别为：（7.40±1.33）次/d、（5.43±1.28）次/d、（3.97±2.03）次/d、（3.33±1.56）次/d和（2.27±1.21）次/d，均有稳定减少，差异有统计学意义（P<0.05）。与术前相比，术后6个月及以后各阶段控便时间>30 min与分辨肛门排气排便，P>0.05；各阶段排便时间<15 min，P<0.05。术后1个月Wexner评分明显低于术前，P<0.001，差异有统计学意义，并随时间延长而逐渐降低。患者术后2年满意度、GIQLI胃肠生活质量评分、Bristol大便形态评分、和Wexner评分分别为93.33%、92.73±13.82、4.60±0.91和7.67±3.21。

腹腔镜次全结肠切除联合改良Duhamel术、直肠前壁悬吊术和子宫圆韧带短缩术能够有效改善混合型便秘的出口梗阻病理因素，具有较好的近远期肛门自制功能、排便功能和排便满意度。

To determine the clinical value of the subtotal colectomy combined with modified Duhamel procedure, anterior rectal suspension and uterine suspension surgery on outlet obstruction for patients with mixed constipation.

From February 2011 to February 2013, 15 female patients underwent laparoscopic procedure at our department. The clinical data and follow-up data were collected for 2 years postoperatively, including Hallbook bowel functional scale, Bristol stool scale, Wexner scale, gastrointestinal quality of life index, and patients’ satisfaction.

The follow-up rate was 100%. The average age was 44.1±13.2 years, and the course of disease was 15.7±9.9 years. Fifteen patients were multipara,and slow transmit constipation was the main reason for constipation.Besides, one or more outlet obstructions were found in these patients. In this article, mild-to-moderate rectocele, rectal mucosal prolapse or fold, retroversion of uterus, descending perineum syndromes were found in 8/15 of patients synchronistically. All patients were followed at 1, 3, 6, 12 and 24 months postoperatively. The defecating frequency was 7.40±1.33/day, 5.43±1.28/day, 3.97±2.03/day, and 3.33±1.56/day respectively. It decreased steadily with significant differences (P<0.05). After Six months postoperatively, there was no significant differences in the ability to defer defecation for more than 30 minutes or feces/flatus differentiation comparing with that in pre-operation (P>0.05). The time of evacuate bowel was less than 15 minutes postoperatively (P<0.05). Wexner scale score was significantly lower than that in pre-operation (P<0.001), and decreased gradually with time. The patients? satisfaction, gastrointestinal quality of life index, Bristol stool scale, and Wexner score in the second year were 93.33%, 92.73±13.82, 4.60±0.91 and 7.67±3.21 respectively.

The subtotal colectomy combined with modified Duhamel procedure, anterior rectal suspension and uterine suspension surgery can improve the outlet obstruction for the mixed constipation. It has better short-term and long-term outcomes in self-control of anus, defecation function and satisfaction.