结肠大部切除术治疗慢传输型便秘

目的评估结肠大部切除术治疗慢传输型便秘的疗效。方法选择慢传输型便秘患者15例,均为排便困难、泻剂依赖,依据结肠传输试验所测得的结果,行结肠大部切除术,术后随访患者排便情况。结果所有患者术后排便困难症状均缓解,排便1~2次/d,为半固体大便,不需口服泻药,无腹泻及肠梗阻等严重并发症,生活质量得到改善。结论对结肠慢传输型便秘患者,依据结肠传输试验所测得的结果,选择性地行结肠大部切除术近期疗效好,远期疗效有待进一步观察。     

结直肠全切除回肠J形储袋肛管吻合术治疗慢传输型便秘

目的 探讨结直肠全切除回肠J形储袋肛管吻合术治疗慢传输型便秘的疗效.方法 对我科收治的慢传输型便秘患者8例,均行结直肠全切除回肠J形储袋肛管吻合术治疗的临床资料作回顾性分析.结果 8例患者术后1个月平均每天大便次数为5.7次(3~10次),呈稀糊状大便.术后6个月平均每天大便次数为3.4次(1.2~4.3次),成形软便.术后1年平均大便次数为1.6次(0.8~3.2次),成形软便.结果 8例患者术后生活质量均得到明显改善.术后1例患者发生储袋炎,经治疗缓解,其余患者未发生严重并发症.结论 结直肠全切除回肠J形储袋肛管吻合术能有效的治疗慢传输型便秘,改善患者生活质量.     

慢传输型便秘患者行结肠次全切除术的护理

对13例慢传输型便秘行结肠次全切除伴逆蠕动盲直肠吻合术患者进行针对性护理,包括心理护理、术前准备、术后引流管的观察及饮食指导.结果13例手术均成功,术后患者便秘症状明显改善,排便均不需用泻剂.提示完善的护理是结肠次全切除术治疗慢传输型便秘的重要保障.     

回肠储粪袋-肛管吻合在全结肠-直肠切除中的应用

目的 探讨回肠储粪袋－肛管吻合在全直肠结肠切除中的应用及效果。方法 回顾性总结１９８０～１９９８年进行的１５例全结肠直肠切除、回肠储粪袋－肛管吻合患者。其中溃疡性结肠炎患者９例,家族性腺瘤性息肉病患者６例,结果 “Ｓ”形储粪袋１０例全结肠直肠切除“Ｊ”储粪袋５例,无死亡病例。手术后发生粘连性肠梗阻４例、伤口感染２例、储粪袋瘘１例、肛瘘１例。随访１２例,随访时间１～１４年。排便次数的中位数为５次／２     

慢传输型便秘患者行结肠次全切除术的护理

对13例慢传输型便秘行结肠次全切除伴逆蠕动盲直肠吻合术患者进行针对性护理，包括心理护理、术前准备、术后引流管的观察及饮食指导。结果13例手术均成功，术后患者便秘症状明显改善，排便均不需用泻剂。提示完善的护理是结肠次全切除术治疗慢传输型便秘的重要保障。     

全结肠切除回肠"S"型储袋肛管吻合术治疗家族性腺瘤性息肉病

目的:探讨全结肠切除回肠“S“型储袋肛管吻合术治疗FAP的效果.方法:回顾分析1995至2005年进行的33例FAP全结肠切除术,对治疗效果进行分析.结果:33例患者中良性21例,癌变12例.全部患者均施行了全结肠切除,27例回肠“S“型储袋肛管吻合术,6例永久性回肠造口术; 手术后无严重并发症发生.33例均得到随访1～10年, 5例癌变病人因肿瘤复发、肝转移死亡.余者术后生存质量满意,排便功能良好. 结论:全结肠切除回肠“S“型储袋肛管吻合术治疗FAP息肉切除彻底、术后控便能力理想,该术式是治疗FAP较为理想的手术方式.     

慢传输型便秘外科不同手术方法的疗效观察与评价

目的 对慢传输型便秘患者采用3种外科手术方法,观察其临床疗效.方法 回顾性的总结2001年8月至2006年5月手术治疗的22例慢传输型便秘患者的资料.结果 A组:采用选择性结肠肠段切除术治疗5例,术后半年内随访,3例大便正常,但有2例便秘复发.B组:采用结肠次全切除和部分直肠切除,行盲直肠吻合术治疗8例,有1例术后半年内便秘复发,其他患者术后半年内排便次数为3～7次/d. C组: 采用全结肠和部分直肠切除,行回直肠吻合术治疗9个病例.患者在术后半年内排便次数为3～8次/d,无一例复发.结论 全结肠和部分直肠切除,行回、直吻合术,是目前治疗慢传输型便秘的首选术式,疗效可靠.     

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目的 探讨结肠慢传输型便秘的诊断及治疗方法，提高诊治水平。方法 对部分顽固性便秘病人的临床症状，结肠软内镜检查，结肠传输试验和排粪造影等的检查结果进行分析，对52例确诊为结肠慢传输型便秘者，进行了手术治疗。其中全结肠切除，回肠与直肠吻合术14例，次全结肠切除，盲肠与直肠吻合术34例，左半结肠切除4例。结果 结肠慢传输型便秘的病理检查可肠壁神经丛有变性，减少，回直肠吻合术后病人大便次数偏多，多数＞3次／日，个别病人半年内每天大便20次左右，半年后次数逐渐减少。左半结肠切除术后仍有排粪困难；而盲直肠吻合术效果较好，多数病人大便1－3次／日。结论 结肠慢传输型便秘的病人行次全结肠切除，盲直肠吻合术效果较好。     

结肠次全切除逆蠕动盲直吻合术和结肠全切除回直吻合术治疗慢传输型便秘的疗效比较

目的比较结肠次全切除、逆蠕动盲直吻合术和结肠全切除回直吻合术治疗重度顽固性慢传输型便秘的疗效,方法分析1999年至2005年间收治的37例单纯慢传输型便秘患者患者4年的随访资料，比较结肠次全切除、逆蠕动盲直吻合术（结肠次全切除组，17例）和结肠全切除、回直吻合术（结肠全切除组，20例）后的排便功能。结果两组患者术前一般资料差异无统计学意义（P〉0．05）。结肠次全切除组每天大便（2．4±0．9）次，显著低于结肠全切除组的每天大便（3．4±0．8）次（P=0．0014）。Wexner肛门失禁评分，结肠全切除组（4．3±1．8）高于结肠次全切除组（5．8±1．9）（P=0．0223）。结肠次全切除组患者术后钡灌肠结果显示盲肠及残余升结肠呈“储袋征”。结论与结肠全切除术相比，结肠次全切除、逆蠕动盲直吻合术可能是部分慢传输便秘患者更好的手术选择。     

家族性腺瘤性息肉病的外科治疗

为了提高家族性腺瘤性息肉病（ＦＡＰ）的外科治疗效果，对１６例ＦＡＰ患者的外科治疗情况进行了回顾性总结。１６例中除１例行全结肠直肠切除、回肠造口外，其余１５例均行全结肠直肠切除、回肠贮袋肛管吻合术。贮袋式中Ｊ型３例、Ｈ型１例，Ｓ型１１例，术后全部患者获１～５年随访，随访结果表明，病人排便功能均较满意，其中以Ｓ型贮袋者为好。笔者认为全结肠直肠切除是治疗ＦＡＰ唯一彻底有效的方法，而回肠贮袋肛管吻合则是减少术后排便次数、提高术后生活质量的良好术式，并讨论了手术方式的选择、手术操作等     

Relationship between gastrointestinal transit time and daily stool frequency in patients after Ileal J pouch-anal anastomosis for ulcerative colitis

BACKGROUND: To investigate how the gastrointestinal transit function changes after ileal J pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) and to study whether gastrointestinal transit time (GTT) has an influence on daily stool frequency, we investigated the relationship between GTT and stool frequency per day. METHODS: Forty patients with UC who had undergone restorative proctocolectomy, with ileostomy closure at least 48 to 120 months (mean 96.3) previously, and who had no preoperative and postoperative complications were recruited. They were divided into two groups on the basis of their stool frequency: 26 patients had a stool frequency of less than 6 times per day (group A: 16 men, 10 women; aged 15 to 59 years old, average 36.6) and 14 patients had a stool frequency of 7 or more times per day (group B: 10 men, 4 women; 24 to 56 years old, average 40.9). The GTTs using a radiopaque marker were studied. Interviews concerning the defecation states were performed at the examination. RESULTS: High nocturnal stool frequency was significantly noted more in group B than in group A (P <0.001). All cases in group A and 12 cases in group B could discriminate flatus from feces, and there were significant differences between groups A and B (P <0.05). Feeling of stool remaining was significantly noted more in group B than in group A (P <0.01). Stool consistency in group A was harder than that in group B (P <0.001). Patients with soiling were significantly noted more in group B compared with those in group A (P <0.001). Incontinence was detected in only 2 cases in group B. Group A showed a better defecation state than group B. In the GTT study, the GTT was almost the same in groups A and B. The small bowel transit, pouch transit, and whole gut transit times in group B were faster than those of group A (P <0.001). Removal length of the terminal ileum in patients after IPAA: patients in group B (13.8 +/- 3.9 cm) had significantly more ileum removed compared with patients in group A (6.3 +/- 2.4 cm; P <0.001). Regression lines in the relationship between removal length of the terminal ileum and individual stool frequency showed there was a correlation between removal length of the terminal ileum and individual stool frequency per day in direct proportion (r = 0.79, P <0.001). A resection of more ileum, up to 15 cm, plays a role in increased stool frequency. CONCLUSIONS: The present results suggested that rapid transit of both the small bowel and pouch may lead to a high stool frequency of 7 or more times per day with a poor defecation state after IPAA. It was also pointed out in this study that an important point is a resection of more ileum, up to 15 cm, plays a role in increased stool frequency.     

智能胶囊结肠压力测定对慢传输型便秘手术方式选择的临床意义

目的探讨智能胶囊结肠压力测定对慢传输便秘术式及疗效的评价作用。方法符合罗马III诊断标准、排除器质性便秘、内科治疗3年以上不缓解、有强力手术意愿的慢传输便秘患者31例,术前及术后半年同步口服智能胶囊结肠压力测定和结肠运输试验。术前检查结果决定手术方式：80%的不透X线颗粒在左半结肠停留超过72 h,或大于总时间的50%,结肠脾曲综合征,智能胶囊结肠压力测定左半结肠停留时间长、压力低幅传输波（low amplitude propagated contractions,LAPCs）及高幅传输波（high amplitude propagated contractions,HAPCs）少于右半结肠50%者行左半结肠切除;80%的不透X线颗粒在右半结肠停留超过72 h,或大于总时间的50%,LAPCs及HAPCs少于左半结肠的50%者行右半结肠切除;结肠运输试验时间〉120 h,消化道压力测定为全结肠压力波明显减少,HPACs少于6次/d者行结肠次全切除;结肠运输时间〉168小时,小肠通过时间〉24 h,消化道压力测定为全结肠压力波明显减少,HAPCs〈2次者行全结肠切除＋回肠直肠切除;16例行传统剖腹手术,15例行腹腔镜手术。结果 31例均恢复出院,术后便秘改善明显改善,术后半年与术前比较智能胶囊的在体总时间、结肠通过时间及群发HAPCs、平均收缩幅度及生理相应比差异有统计学意义,但HAPCs及LAPCs数差异无统计学意义,结肠传输时间术后显著少于术前。腹腔镜手术组和传统手术组相比,术后肠粘连及肠梗阻发生率明显减少,3例全结肠切除术者术后早期腹泻明显。结论智能胶囊结肠压力波测定对手术方式选择有一定的指导意义,腹腔镜较传统手术创伤小、并发症少,有望成为慢传输便秘治疗的标准术式。     

三环形回肠贮袋-肛管吻合术在全结肠切除术中的应用

目的探讨全结肠切除后三环形回肠贮袋-肛管吻合加选择性截流术的价值。方法1994年9月至2004年9月对18例全结肠切除患者应用三环形回肠贮袋加选择性截流术,其中家族性大肠腺瘤性息肉病14例,溃疡性结肠炎4例。结果18例获12月～5年随访,无手术死亡。术后发生并发症3例(16.7%),贮袋阴道瘘、早期炎性肠梗阻、切口感染各1例,均治愈。术后平均排便频率:术后2周内4.9次/d,1个月3.8次/d,6个月3.1次/d,1年1.8次/d。至6个月时都能控制干便,其中控制正常者15例(83.3%),控制欠佳者3例(16.7%),无大便失禁。但稀便控制能力较差,至1年时仍有1例(5.6%)患者稀便失禁。无一例须插管排空。结论全结肠切除后三环形回肠贮袋肛管吻合加选择性截流术操作简单,手术并发症少,术后排便功能好,是家族性大肠腺瘤性息肉病和严重溃疡性结肠炎全结肠切除后较为合适的消化道重建方式。     

慢传输型便秘合并盆底疝和直肠黏膜内脱垂手术治疗的远期疗效

目的 评估结肠次全切除升结肠直肠吻合、盆底疝修补、功能性直肠悬吊、子宫悬吊术治疗慢传输型便秘合并盆底疝和直肠黏膜内脱垂的远期疗效.方法 对2007年6月至2008年5月35例结肠慢传输合并盆底疝、直肠黏膜内脱垂所致顽固性便秘患者行结肠次全切除升结肠直肠吻合、盆底疝修补、功能性直肠悬吊、子宫悬吊术.术后随访患者的排便情况、并发症、生活质量及满意度.结果 平均随访期2年.35例患者术后无严重并发症及死亡.术后1个月每天平均排便5(2～8)次,为半固体状大便.术后2年平均每天排便2(1～3)次,为固体状大便.随访期间35例患者控便能力良好,无大便失禁发生.35例中对手术效果满意者19例,非常满意者16例.35例患者生活质量均得到明显改善,其中术后需间断性使用泻药者3例.结论 结肠次全切除升结肠直肠吻合、盆底疝修补、功能性直肠悬吊、子宫悬吊术是慢传输型便秘合并盆底疝、直肠黏膜内脱垂的有效治疗方法,远期效果满意.

Abstract：

Objective To evaluate the long-term therapeutic efficacy of subtotal colectomy,ascending colon-rectum anastomosis, pelvic floor hernia repair, functional rectal suspension, and uterine suspension surgery for slow transit constipation with pelvic floor hernia and rectal mucosal prolapse.Methods From June 2007 to May 2008, 35 patients with intractable constipation caused by slow colonic transit combined with pelvic floor hernia and rectal mucosal prolapse underwent subtotal colectomy and ascending colon-rectum anastomosis, pelvic floor hernia repair, functional rectal suspension, and uterine suspension surgery. Postoperative defecation, complications, quality of life, and degree of satisfaction were followed-up. Results The average follow-up period was two years. At one month after the operation, the average defecation frequency was five times (2 -8 times) a day, with a semi-liquid stool consistency; After two years the frequency was twice ( 1 -3 times) a day, with solid stool consistency. Of the 35 patients, 19 were satisfied with the surgical efficacy, and 16 were very satisfied. All the patients' quality of life improved significantly. Conclusions For patients suffering from slow transit constipation with pelvic floor hernia and rectal mucosal prolapse subtotal colectomy, ascending colon-rectum anastomosis, pelvic floor hernia repair,functional rectal suspension, and uterine suspension surgery has satisfactory results.     

系统化整体护理模式对肛裂患者术后疼痛及便秘的效果观察

为观察系统化整体护理模式对肛裂患者术后疼痛及便秘的效果,将肛裂手术患者184例随机分为对照组和观察组,每组92例。对照组患者术后采用常规护理,观察组患者术后采用系统化整体护理模式护理;比较2组患者术后疼痛及便秘效果。结果显示,观察组患者术后疼痛评分低于对照组(P <0.05),观察组患者3d未排便、用力排便、排便堵塞、粪便干硬比率低于对照组(P <0.05)。结果表明,系统化整体护理模式能有效缓解肛裂患者术后疼痛,改善肛裂术后患者便秘症状。     

大黄粉敷脐防治痔术后便秘的疗效观察

为探讨大黄粉外敷脐部（神阙穴）防治痔术后便秘的临床疗效,将60例行PPH加外痔切除术治疗的痔患者随机分为观察组和对照组,各30例。对照组予常规治疗（中药液熏洗坐浴、药物口服、局部红外线理疗）,观察组在常规治疗的基础上,予大黄粉外敷神阙穴。对比观察两组患者术后排便情况。结果显示,观察组术后排便情况评分明显低于对照组,P〈0．05。结果表明,大黄粉敷脐有缓泻通便作用,可有效防治痔术后便秘。     

盆底生物反馈疗法加针刺八谬穴治疗盆底失弛缓综合征所致便秘的临床疗效

为探讨盆底生物反馈疗法加针刺八髂穴治疗盆底失弛缓综合征所致便秘的临床疗效,将60例盆底失弛缓综合征所致的便秘患者随机分为治疗组和对照组,各30例,治疗组给予盆底生物反馈治疗加针刺八露穴,对照组单纯给予生物反馈疗法治疗。比较两组患者治疗后排便情况、肛门测压情况及总体疗效。结果显示,两组患者治疗前排便情况各指标评分及肛门测压结果比较,差异均无统计学意义,P〉0．05。治疗后两组患者排便周期、排便时间、排便方式、排便不尽感、肛门坠胀感、便质方面评分及肛管静息压、肛管最大缩榨压、直肠初始感觉阈值、直肠最大耐受阈值均下降,其中治疗组各指标下降更明显,P〈0．05或P〈0．01或P〈0．001。治疗组总有效率明显高于对照组,P〈0．05。结果表明,盆底生物反馈疗法加针刺八髂穴治疗盆底失弛缓综合征所致便秘简便易行,效果显著。     

The association of obstructive defecation,lower urinary tract dysfunction and the benign joint hypermobility syndrome: A case–control study

It has been suggested that, apart from obstetric trauma, chronic straining at stool may also result in pudendal nerve damage, contributing to the etiology of genuine stress incontinence (GSI). The benign joint hypermobility syndrome (BJHS) has been associated with rectal as well as uterovaginal prolapse, suggesting that connective tissue abnormalities may also be implicated. This study was undertaken in order to further investigate whether - and if so, why - an association may exist between symptoms of obstructive defecation, lifetime constipation, chronic heavy lifting and lower urinary tract (LUT) dysfunction. Cases were female patients referred for urodynamic assessment with symptoms of LUT dysfunction. Controls were age-, sex- and postcode-matched community controls. Both cases and controls were assessed using a detailed questionnaire that also asked about symptoms of BJHS. Cases were also divided into their urodynamic classification of LUT dysfunction. All symptoms of obstructive defecation (52.3% vs 33.6%, P=0.00003), as well as chronic straining at stool (38.6% vs 23.4%, P=0.0005), were significantly more common in women with LUT dysfunction than in community controls. BJHS, chronic heavy lifting and a history of uterovaginal prolapse were significantly associated with patients with LUT and obstructive defecation compared to those with LUT dysfunction alone. Overall, symptoms of obstructed defecation were not more prevalent in any one urodynamic diagnostic group than in others. However, childhood constipation and current constipation were significantly more prevalent in women with voiding dysfunction than in those with other urodynamic diagnoses (16.7% vs 5.5%, P = 0.0030 and 13.0% vs 5.7%, P = 0.017). We concluded that women with LUT dysfunction are more likely to have symptoms of obstructive defecation than are community controls. Connective tissue disorders such as BJHS may be an important factor in this association.     

聚乙二醇4000防治肛肠病术后大便困难的疗效观察

目的探讨聚乙二醇4000（长松）防治肛肠病术后大便困难的临床疗效。方法将121例患者按入院顺序分为2组,治疗组61例,术后每天睡前服聚乙二醇4000散剂10g,1次/d,对照组60例,术后每天睡前服麻仁九6g,1次/d。观察两组患者服药后第1次排便距服药的时间、术后第2～5d两组患者大便通畅及排便时肛门疼痛情况。结果两组患者在服药后第1次排便距服药的时间方面有差异有统计学意义（P〈0.05）,治疗组优于对照组。术后第2～5d大便通畅及排便时肛门疼痛情况差异无统计学意义（P〉0.05）。结论聚乙二醇4000能有效防治肛肠病术后大便困难。     

滋阴润肠流膏口服治疗功能性便秘的疗效观察

为观察滋阴润肠流膏口服治疗功能性便秘的临床效果,将60例功能性便秘患者随机分为治疗组和对照组,每组各30例。治疗组采用口服滋阴润肠流膏治疗,对照组采用口服六味能消胶囊治疗。两组均以4周为1个疗程,观察两组的临床疗效,并对治愈患者随访2个月,观察远期疗效。结果显示,治疗组在排便不尽感、排便困难、排便频率及大便性状等方面疗效明显优于对照组（P〈0．05）。结果表明,滋阴润肠流膏口服治疗功能性便秘更为有效、安全,具有服用剂量较小、便于久服、服用适口、生物利用度高、强健补益等独特的优点。