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中华结直肠疾病电子杂志 ›› 2022, Vol. 11 ›› Issue (05) : 392 -398. doi: 10.3877/cma.j.issn.2095-3224.2022.05.007

论著

腹腔镜次全结肠旷置造口盲直肠吻合术治疗老年慢传输型便秘的临床疗效观察
曹永丽1, 王思远1, 李宜璐2, 吕兵兵1, 张春旭3, 杨阳1, 张远耀1, 杨维维1, 张文丽1, 魏东1,()   
  1. 1. 471031 洛阳,中国人民解放军联勤保障部队第九八九医院全军肛肠外科研究所
    2. 453003 新乡医学院研究生处
    3. 450000 郑州,中国人民解放军联勤保障部队第九八八医院普通外科
  • 收稿日期:2022-05-19 出版日期:2022-10-25
  • 通信作者: 魏东
  • 基金资助:
    河南省医学科技攻关项目(2011030031)

Clinical observation of laparoscopic subtotal colostomy and ceco-rectal anastomosis in the treatment of senile slow transit constipation

Yongli Cao1, Siyuan Wang1, Yilu Li2, Bingbing Lv1, Chunxu Zhang3, Yang Yang1, Yuanyao Zhang1, Weiwei Yang1, Wenli Zhang1, Dong Wei1,()   

  1. 1. Institute of Anal-Colorectal Surgery, the 989th Hospital of the Joint Logistics Support Force of PLA, Luoyang 471031, China
    2. Postgraduate Department, Xinxiang Medical University, Xinxiang 453003, China
    3. Department of Anal-Colorectal Surgery, the 988th Hospital of The Joint Logistics Support Force of PLA, Zhengzhou 450000, China
  • Received:2022-05-19 Published:2022-10-25
  • Corresponding author: Dong Wei
引用本文:

曹永丽, 王思远, 李宜璐, 吕兵兵, 张春旭, 杨阳, 张远耀, 杨维维, 张文丽, 魏东. 腹腔镜次全结肠旷置造口盲直肠吻合术治疗老年慢传输型便秘的临床疗效观察[J/OL]. 中华结直肠疾病电子杂志, 2022, 11(05): 392-398.

Yongli Cao, Siyuan Wang, Yilu Li, Bingbing Lv, Chunxu Zhang, Yang Yang, Yuanyao Zhang, Weiwei Yang, Wenli Zhang, Dong Wei. Clinical observation of laparoscopic subtotal colostomy and ceco-rectal anastomosis in the treatment of senile slow transit constipation[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2022, 11(05): 392-398.

目的

对比观察腹腔镜次全结肠旷置盲直肠吻合术和腹腔镜次全结肠旷置造口盲直肠吻合术治疗老年慢传输型便秘的临床疗效。

方法

采用回顾性队列研究的方法,收集中国人民解放军联勤保障部队第九八九医院全军肛肠外科研究所于2008年12月至2017年12月期间收治的年龄≥70岁的70例结肠慢传输型便秘患者的病例资料,其中34例采用腹腔镜次全结肠旷置盲直肠吻合术进行治疗(结肠旷置手术组),36例采用腹腔镜次全结肠旷置造口盲直肠吻合术治疗(结肠旷置造口组),对比两种手术方式的临床治疗效果及两组间各项评分量表。对比术后3个月、6个月、12个月每天排便次数(BM)和Wexner肛门失禁评分(WIS),以及术前和术后3个月、6个月、12个月、24个月Wexner便秘评分(WCS)、胃肠生活质量指数(GIQLI),腹胀评分(ABS)和0~10数字疼痛量表(NRS)。

结果

所有患者均顺利进行了腹腔镜手术,术后均未发生排便失禁。术后3个月、6个月、12个月结肠旷置造口组的BM和WIS均明显少于结肠旷置手术组,差异有统计学意义[(BM)F3=8.075、F6=4.254、F12=15.617,(WIS)F3=11.760、F6=14.422、F12=27.467;均P<0.05]。术后3个月、6个月、12个月、24个月结肠旷置造口组WCS和GIQLI改善明显优于结肠旷置手术组[(WCS)F3=4.132、F6=4.028、F12=18.780、F24=23.224,(GIQLI)F3=75.194、F6=44.631、F12=52.238、F24=89.949;均P<0.05]。术后3个月结肠旷置造口组的ABS与结肠旷置手术组比较差异无统计学意义(F=2.423,P>0.05);术后6个月、12个月、24个月结肠旷置造口组ABS改善明显优于结肠旷置手术组(F6=20.846,F12=54.045,F24=85.039;均P<0.05)。术后3个月结肠旷置造口组的NRS与结肠旷置手术组比较差异无统计学意义(F=1.635,P>0.05),术后6个月、12个月、24个月结肠旷置造口组的NRS与结肠旷置手术组比较得到明显改善(F6=4.057,F12=33.661,F24=36.421;均P<0.05)。手术1年后钡餐检查,结肠旷置造口组的钡剂排空时间为21.0(18.3,24.0)h,明显短于结肠旷置手术组58.5(39.0,101.5)h,两组比较差异有统计学意义(Z=-6.651,P<0.05)。

结论

腹腔镜次全结肠旷置造口盲直肠吻合术治疗老年慢传输型便秘是一种较理想的手术方法,临床效果优于腹腔镜次全结肠旷置盲直肠吻合术。

Objective

To compare the clinical efficacy of laparoscopic subtotal colonic exclusion and ceco-rectal anastomosis and laparoscopic subtotal colostomy and ceco-rectal anastomosis in the treatment of senile slow transit constipation.

Methods

A retrospective cohort study was conducted to collect the data of 70 patients with colonic slow transit constipation aged ≥70 years treated in the Institute of Anal-Colorectal Surgery of the 989th Hospital of the Joint Logistics Support Force of PLA from December 2008 to December 2017, including 34 cases treated with laparoscopic subtotal colonic exclusion and ceco-rectal anastomosis (colonic exclusion group), thirty-six cases treated with laparoscopic subtotal colostomy and ceco-rectal anastomosis (colostomy group) .The clinical therapeutic effects of the two surgical methods and the scores between the two groups were compared. The number of daily bowel movements (BM) and Wexner fecal incontinence scale (WIS) at 3, 6 and 12 months after operation, Wexner constipation grading score (WCS), gastrointestinal quality of life index (GIQLI), abdominal bloating score (ABS) and 0~10 numerical rating scale for pain intensity (NRS) at 3, 6, 12 and 24 months before and after operation were compared.

Results

All patients underwent laparoscopic surgery successfully, and no fecal incontinence occurred after operation. At 3, 6 and 12 months after operation, the BM and WIS in the colostomy group were significantly lower than those in the colonic exclusion group [(BM)F3=8.075, F6=4.254, F12=15.617, (WIS)F3=11.760, F6=14.422, F12=27.467; P<0.05]; At 3, 6, 12 and 24 months after operation, the improvement of WCS and GIQLI in the colostomy group was significantly better than that in the colonic exclusion group [(WCS)F3=4.132, F6=4.028, F12=18.780, F24=23.224, (GIQLI)F3=75.194, F6=44.631, F12=52.238, F24=89.949; P<0.05); There was no significant difference in ABS between the colostomy group and the colonic exclusion group 3 months after operation (F=2.423, P>0.05); At 6, 12 and 24 months after operation, the improvement of ABS in the colostomy group was significantly better than that in the colonic exclusion group (F6=20.846, F12=54.045, F24=85.039; P<0.05); At 3 months after operation, there was no significant difference in NRS between the colostomy group and the colonic exclusion group (F=1.635, P>0.05). At 6, 12 and 24 months after operation, NRS in the colostomy group was significantly improved compared with the colonic exclusion group (F6=4.057, F12=33.661, F24=36.421; P<0.05). One year after operation, barium meal examination showed that the barium emptying time of the colostomy group was 21.0(18.3, 24.0) h, which was significantly shorter than that of the colonic exclusion group 58.5(39.0, 101.5) h, and there was significant difference between the two groups (Z=-6.651, P<0.05).

Conclusion

Laparoscopic subtotal colostomy and ceco-rectal anastomosis is an ideal surgical method for the treatment of senile slow transit constipation, and its clinical effect is better than laparoscopic subtotal colonic exclusion and ceco-rectal anastomosis.

表1 两组一般资料比较(
xˉ
±s
表2 两组围手术期指标比较[
xˉ
±s,例(%)]
表3 BM及WIS评分比较(
xˉ
±s,分)
表4 WCS、GIQLI、ABS、NRS评分比较(
xˉ
±s,分)
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