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中华结直肠疾病电子杂志 ›› 2023, Vol. 12 ›› Issue (06) : 478 -483. doi: 10.3877/cma.j.issn.2095-3224.2023.06.007

论著

腹腔镜次全结肠切除术治疗顽固性慢传输型便秘的疗效分析
邰清亮, 施波, 侍新宇, 陈国梁, 陈俊杰, 武冠廷, 王索, 孙金兵, 顾闻, 叶建新(), 何宋兵()   
  1. 215006 苏州大学附属第一医院普外科
    215200 苏州市第九人民医院普外科
    215228 苏州,江苏盛泽医院普外科
    215501 苏州,常熟市第一人民医院普外
    215006 苏州大学附属第一医院消化内科
  • 收稿日期:2023-11-08 出版日期:2023-12-25
  • 通信作者: 叶建新, 何宋兵
  • 基金资助:
    苏州市姑苏卫生重点人才项目(No. GSWS2020005); 苏州市医工结合协同创新研究项目(No. SLJ2021007)

Clinical effectiveness of laparoscopic subtotal colectomy in the treatment of intractable slow transit constipation

Qingliang Tai, Bo Shi, Xinyu Shi, Guoliang Chen, Junjie Chen, Guanting Wu, Suo Wang, Jinbing Sun, Wen Gu, Jianxin Ye(), Songbing He()   

  1. Department of General Surgery, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
    Department of General Surgery, Suzhou Ninth People's Hospital, Suzhou 215200, China
    Department of General Surgery, Jiangsu Shengze Hospital, Suzhou 215228, China
    Department of General Surgery, Changshu No.1 People's Hospital, Suzhou 215501, China
    Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
  • Received:2023-11-08 Published:2023-12-25
  • Corresponding author: Jianxin Ye, Songbing He
引用本文:

邰清亮, 施波, 侍新宇, 陈国梁, 陈俊杰, 武冠廷, 王索, 孙金兵, 顾闻, 叶建新, 何宋兵. 腹腔镜次全结肠切除术治疗顽固性慢传输型便秘的疗效分析[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 478-483.

Qingliang Tai, Bo Shi, Xinyu Shi, Guoliang Chen, Junjie Chen, Guanting Wu, Suo Wang, Jinbing Sun, Wen Gu, Jianxin Ye, Songbing He. Clinical effectiveness of laparoscopic subtotal colectomy in the treatment of intractable slow transit constipation[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2023, 12(06): 478-483.

目的

探讨腹腔镜次全结肠切除术(SC)治疗顽固性慢传输型便秘(STC)的疗效。

方法

收集2017年5月至2023年8月在苏州大学附属第一医院47例明确诊断为慢传输型便秘并行腹腔镜SC治疗的患者围手术期及随访资料,包括手术时间、术中出血量、首次排便时间,以及术前术后的Wexner便秘评分(WCS)和自发排便次数(SCBM)变化等。

结果

47例患者平均手术时间(266.09±77.72)min,术中出血量100(100,200)mL,预防性造口3例;首次离床时间2(1,3)天,首次进食时间3(2,4)天,首次排便时间3(3,4)天;术后并发症8例,其中术后肠梗阻2例,术后吻合口漏和出血各3例。术前WCS评分18(16,20)分,术后WCS评分4(3,4)分,分值明显下降(Z=5.979,P<0.05);术前SCBM为1(0,1)次/天,术后为3(2,3)次/天,次数明显上升(Z=6.028,P<0.05)。

结论

腹腔镜SC治疗顽固性慢传输型便秘疗效肯定、创伤小、并发症少,是较理想的外科治疗方法。

Objective

To evaluate the effectiveness of laparoscopic subtotal colectomy(SC) in the treatment of intractable slow transit constipation (STC).

Methods

Clinical and follow-up data of 47 patients with intractable STC treated by laparoscopic SC in the First Affiliated Hospital of Soochow University from May 2017 to August 2023 were collected and retrospectively analyzed in this study. Operation time, intraoperative blood loss, first defecation time, and pre-and post-operative number of Wexner constipation score (WCS) and spontaneous complete bowel movement (SCBM) were analyzed.

Results

The average operation time of the 47 patients was (266.09±77.72) min, the intraoperative blood loss was 100 (100, 200) mL, three cases had prophylactic ileostomy; the first time of leaving bed was 2(1, 3) d, the first time of feeding was 3(2, 4) d, the first time of defecation was 3(3, 4) d; there were 8 postoperative complications, including 2 cases of postoperative ileus, three case of postoperative anastomotic hemorrhage and leakage. The preoperative WCS score was 18(16, 20) points, and the postoperative WCS score was 4(3, 4) points, with a significant decrease in scores (Z=5.979, P<0.05); the preoperative SCBM was 1(0, 1) times/day, and the postoperative SCBM was 3(2, 3) times/day, with a significant increase in frequency (Z=6.028, P<0.05).

Conclusion

Laparoscopic SC is an ideal surgical treatment method for the treatment of intractable STC with certain efficacy, minimal trauma, and few complications.

图1 纳入及筛选患者数据的流程图
图2 腹腔镜SC手术过程。2A:尾侧入路游离回盲部,扩展层面;2B:保留回结肠血管,处理右结肠血管,中结肠血管;2C:按头侧、外侧、内侧游离脾区;2D:调整人员及镜子,处理肠系膜下血管;2E:离断远端直肠;2F:升结肠-直肠端端吻合
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