慢传输型便秘的外科治疗(附31例报告)

目的 探讨慢传输型便秘外科治疗方法.方法 2004年1月至2010年8月对31例慢传输型便秘病人采用大肠次全切除、直肠低位前切除术、升结肠直肠低位吻合术及末端回肠预防性造口术.结果 全组无死亡病例,未发生肠瘘、盆腔感染、吻合口狭窄、粘连性肠梗阻、肛门失禁等并发症.30例排便功能满意,每天大便次数平均4次;1例术后便秘...     

结肠慢传输性便秘外科治疗国内外进展

结肠慢传输性便秘(colon slow transit constipation,CSTC)又被称为慢通过性便秘或结肠无力(colonic inertia),是指结肠传输功能障碍,肠内容物通过缓慢所引起的便秘。该病病因不清,症状顽固,影响因素较多。尽管结肠次全(全)切除术对大部分患者取得了较好的效果,但怎样更精确全面地诊断结肠慢传输性便秘,以便选择合适的手术方式从而取得更好的效果;怎样探索结肠慢传输性便秘的发病机理从而在根本上进行防治,仍然是目前这一领域研究的热点。现就结肠慢传输性便秘外科治疗的手术指征、手术方式的选择以及疗效谈谈笔者的一些看法,不足之处请各…     

结肠慢传输性便秘外科治疗中的热点问题

结肠慢传输性便秘(colon slow transit constipation,CSTC)是以结肠动力减弱为特征的顽固性便秘,表现为结肠传输减慢、无便意、大便次数明显减少。其发病的主要机制与结肠巨大迁移性收缩波的减少有关,而后者又受肠道平滑肌、肠神经系统和内分泌系统综合调控。该病症状顽固,内科治疗效果不佳,大部分患者最终需要手术切除结肠。多数经手术治疗虽可取得满意效果,但术后腹泻、粘连性肠梗阻、便秘复发依然是外科治疗中所面临的棘手问题。另外,结肠慢传输性便秘是功能性疾病,本身不危及患者生命,患者求助于手术是为了提高生活质量。因此,对手术结果要求很高,不但希望取得满意的治疗效果,恢复良好的排便和控便功能,同时也希望避免出现各种并发症。     

手术治疗结肠慢传输型便秘的疗效评价(附12例报告)

对12例结肠慢传输型便秘手术治疗后的随访结果分析,结合文献评价了全结肠切除术、次全结肠切除术、左半结肠切除术疗效及并发症。指出,必须于术前明确慢传输结肠的范围,选择合适的切除范围方能收到良好的效果。     

结肠慢传输型便秘24例外科治疗体会

目的 探讨结肠慢传输型便秘(slow transit constipation,STC)病人的合理手术方式.方法 回顾性分析了24例接受手术治疗的结肠STC病人的临床资料.结果 结肠次全切除、逆蠕动盲肠直肠吻合术10例,结肠大部分旷置、逆蠕动盲肠直肠吻合术8例,结肠旷置、回肠直肠吻合术4例,结肠旷置、回肠乙状结肠吻合术...     

结肠慢转运型便秘的外科治疗

我科 1995— 2 0 0 1年共收治结肠慢转运型便秘患者 18例 ,根据临床症状、体征 ,结合特殊检查取得确诊 ,行次全结肠切除、盲直肠吻合术 ,取得满意效果 ,现报告如下。1　临床资料本组 18例 ,男性 3例 ,女性 15例 ;年龄 31～ 6 5岁 ,平均 4 8 5岁。病史 7～ 32年 ,平均 17年。排便间隔 7～ 10d 10例 ,11～ 16d 5例 ,16d以上 3例 ,其中长期依赖泻剂协助排便 7例。主要临床表现为自然便次减少 ,便意缺乏 ,常 1～ 2周不排便 ,伴有腹胀、腹痛、纳差、烦燥等。长期依赖各种泻剂排便 ,对泻剂敏感度逐渐下降。结肠运输功能试验提示 :标记物排出 80 %…     

结肠慢传输型便秘的临床特点及外科治疗(附84例分析)

为总结评价结肠慢传输型便秘(STC)的临床特征、手术治疗效果及结肠的病理变化,回顾性分析手术治疗的84例STC的病理特征、手术方式及治疗效果.结果显示,84例STC患者结肠传输均明显减慢,主要临床表现为排便间隔时间延长,平均1次/(6.8～9.4)d,92.9%患者依靠服用泻剂排便,97.6%患者伴有盆底肌功能不良.大...     

手术治疗结肠慢传输型便秘的疗效评价（附12例报告）

对12例结肠慢传输型便秘手术治疗后的随访结果分析，结合文献评价了全结肠切除术、次全结肠切除术、左半结肠切除术疗效及并发症。指出，必须于术前明确慢传输结肠的范围，选择合适的切除范围方能收到良好的效果。     

结肠次全切除术治疗动力型便秘 (附3例报告)

报告结肠动力型便秘3例.其中结肠慢运输型(STC)2例、巨结肠致慢性便秘1例.经采用结肠次全切除加盲、直肠吻合术,取得满意效果.结肠运输时间测定是诊断STC的一个重要依据,在经过排粪造影、气囊逼出试验等排外功能性出口处梗阻前提下,结肠次全切除术为内科保守治疗无效的结肠动力型便秘的一种行之有效的治疗方法.     

结肠慢运输型便秘的诊断及治疗（附8例报告）

本文报告了经结肠运输时间等综合检查确诊的结肠慢运输型便秘(STC)8例。通过对病因、诊断、手术适应证、手术方式及并发症防治等方面的讨论,作者认为:结肠运输时间测定是诊断STC的一个重要依据,结肠次全切除加盲、直肠吻合术为内科保守治疗无效的STC的一种有效治疗方法。     

顽固结肠慢传输性便秘16例的临床分析

目的：探讨顽固性结肠慢传输性例秘的合理治疗方法。方法：总结顽固性结肠慢传输性便秘患者经X线钡灌肠以及排粪造影检查,结合临床特征而决定手术切除冗长结肠12例,4例非手术治疗,其中冗长横结肠4例,冗长乙状结肠12例。伴直肠前凸3例,重度直肠膨出,盆底下降1例,4例患者中3例经肛修复,1例经腹修复,重建盆底。3例乙状结肠冗长扭转行急诊手术。结果：11例患者恢复良好,有1例高龄患者仅行扭转乙状结肠复位而于术后10d死亡,随访3年,1例有肠粘连症状,1例切口感染,4例非手术治疗症状未缓解。结论：顽固性结肠慢传输性便秘冗长结肠是其原因之一,需早期手术切除,伴有直肠前凸,盆底下降可一期手术修复,如待急诊肠扭转再手术,则危险较大、甚至危及生命,而非手术治疗症状不得缓解,且造成药物依赖。     

慢传输性便秘结肠平滑肌肌动蛋白改变

目的：深入地了解慢传输性便秘的发病机理和病理生理改变。方法：以免疫组化方法检测了STC患者结肠平滑肌收缩蛋白－肌动蛋白的变化。结果：与正常对照组相比,慢传输性便秘患者结肠黏膜下肌层、纵肌层内α肌动蛋白量明显减少（P＜0．01）,而环肌层内α肌动蛋白变化不明显（P＞0．05）。结论：推测这种平滑肌收缩蛋白的减少和分布异常导致了慢传输性便秘病人结肠运动功能的紊乱。     

慢传输性便秘结肠神经系统的病理生理改变

目的：了解慢性输性便秘（STC）结肠壁神经系统的病理改变。方法：用免疫组化法检测了慢性输性便秘病人结肠肠壁神经元凋亡现象。结果：STC患者结肠壁神经元有凋亡现象发生，神经元内bcl-2含量下降，而bax无显著变化。结论：这种不恰当的细胞死亡－－病理性神经元凋亡可能在STC的发病过程中具有重要意义，提示通过抑制凋亡的发生是预防和治疗STC的一个有效途径。     

慢传输型便秘结肠肌间神经丛形态学改变及其临床意义

目的：探讨慢传输型便秘（ＳＴＣ）结肠传输缓慢的神经病理学基础。方法：对１４例ＳＴＣ患者的乙状结肠全层组织进行常规ＨＥ染色、肌间神经丛Ｈｏｌｍｅｓ银浸染色以及Ｓ－１００蛋白免疫组化染色等研究。并与１１例非梗阻性直肠癌患者的正常乙状结肠标本作对照。结果：１４例ＳＴＣ患者乙状结肠肌间神经丛嗜银性反应较对照组均有不同程度的降低，神经纤维排列紊乱并有缠结现象。肌间神经丛内Ｓ－１００蛋白的免疫反应性在ＳＴＣ组     

LAPAROSCOPIC-ASSISTED COMPARED WITH OPEN TOTAL COLECTOMY IN TREATING SLOW TRANSIT CONSTIPATION

Background : Total colectomy is the procedure of choice when slow transit constipation (STC) can be confidently diagnosed. A laparoscopic-assisted technique (LTC) may be potentially advantageous over traditional open technique (OTC) in the treatment of this benign condition. Methods : A historical control (non-randomized) study was performed on patients diagnosed to have STC after clinical, anorectal physiologic and transit marker studies. All earlier consecutive patients underwent OTC and the latter consecutive patients underwent LTC. The intra-operative time, blood loss, postoperative ileus recovery, duration of hospitalization and complications were recorded. A bowel function and patient satisfaction questionaire was administered on follow-up. Results : Twenty-four of 411 patients were found to have STC; 17 (2 men, 15 women; mean age, 40 (standard error of mean [SEMI 5) years) underwent OTC and 7 (2 men, 5 women; mean age, 39.5 (SEM 6) years) underwent LTC. There were significant improvements in the stool frequency, need for assisted evacuation and abdominal distension (P < 0.05) after both procedures; 96% were fully satisfied with the resulting bowel function. However, OTC patients were less satisfied with the cosmetic outcome (P < 0.05). Intra-operative time for LTC was longer by a mean 74 min (P < 0.05). Postoperative blood loss, recovery of ileus and hospitalization time were the same in both groups. There were no deaths. The complication rates were 43% for LTC and 24% for OTC. The predominant complication was bowel obstruction for which two patients (both OTC) required adhesiolysis. Conclusions : Both OTC and LTC improve bowel function for STC; LTC gives a better cosmetic result, but takes longer to perform.     

SURGERY FOR SEVERE CONSTIPATION: THE USE OF RADIOISOTOPE TRANSIT SCAN AND BARIUM EVACUATION PROCTOGRAPHY IN PATIENT SELECTION

Nineteen women aged 19–64 years (median 38) with intractable constipation were assessed by Indium-111 DTPA colonic transit scan and barium evacuation proctogram. Patients were classified as having an isolated (I) or predominant disorder of colonic transit (II). a mixed disorder of colonic transit and rectal evacuation (III), a predominant disorder of rectal evacuation (IV) or normal colorectal emptying (V). Twelve patients fell into categories I and II and were considered suitable for surgery. Three responded to further vigorous aperient therapy and nine (32–55 years, median 38) underwent subtotal colectomy with ileorectal anastomosis at the level of the sacral promontory. Two patients required re-operation for suspected anastomotic leak. One patient required readmission on two occasions for small bowel obstruction. Follow up has been 2–21 months (median 16). Eight of the nine patients no longer take oral aperients. Eight patients have a satisfactory stool frequency of 2–8 per 24 h; the other patient has an ileostomy and incapacitating postprandial abdominal pain. Abdominal pain is troublesome in two other patients. Two patients require antidiarrhoeal therapy but none experience faecal incontinence. In severely constipated patients with a proven disorder of colonic transit but normal or near normal rectal evacuation subtotal colectomy provides excellent symptomatic relief.     

慢传输型便秘乙状结肠壁内一氧化氮合酶分布的免疫组化研究

对15例慢传输型便秘(STC)患者乙状结肠壁内一氧化氮合酶(NOS)的分布进行免疫组织化学研究和半定量分析,结果表明肌间神经丛NOS阳性细胞明显增多(P<0.05),粘膜下丛无明显变化(P>0.05).提示一氧化氮的过量产生抑制了肠平滑肌的收缩,可能是STC发病的原因之一.     

左侧结肠憩室炎诊断与治疗体会（附29例报告）

本文介绍我院４６年来收治的２９例左侧结肠憩室炎病人的诊治情况。２９例全部作了手术，其中急诊手术２２例，择期手术７例。诊断主要依靠病史、体征、泛影葡胺灌肠和ＣＴ检查。提出急诊手术与择期手术的手术指征，手术方式的选择方法。对各种手术方式的利弊作了比较。因结肠憩室炎易复发，复发周期在３～４个月．因此择期手术强调在第一次复发后３个月作手术。又因年轻病人予后常较严重，强调第一次发作后３～４周积极行手术治疗。     

A LONG-TERM FOLLOW-UP OF PATIENTS UNDERGOING COLECTOMY FOR CHRONIC IDIOPATHIC CONSTIPATION

Background: Chronic idiopathic constipation is a condition that mainly affects young women and is commonly associated with symptoms of abdominal pain and bloating. It has been proposed that patients with severe symptoms who are unresponsive to conservative measures can be managed by colonic resection. The aim of the present study was to assess the long-term outcome of such surgery on patients with a diagnosis of chronic idiopathic constipation. Methods: Ninety-six patients (92 females, 4 males) underwent either a total colectomy and ileorectal anastomosis (n= 86) or subtotal colectomy and caecorectal anastomosis (n= 10) between 1986 and 1994. Results: Postoperative mortality was 2.1%, 3.1% suffered from an anastomotic leak and 11.5% developed a pelvic abscess. Follow up was completed in 92.7% of patients at a mean of 5.0 & 2.3 years. Following surgery, symptomatic improvement was reported by 81.6% of patients. However, 51.2% still experienced difficulty with straining, 50.6% had some degree of anal incontinence, 55.2% continued to experience abdominal pains and 75.9% continued to be troubled by abdominal bloating. Re-operation was performed on 35.6% of patients (mainly for division of adhesions), and 9.2% of patients required an ileostomy. Conclusions: Colectomy is associated with relief of constipation in a majority of patients with chronic idiopathic constipation. However, it is associated with a considerable morbidity and is less effective in resolving symptoms of abdominal pain and bloating.     

大肠癌肝转移的外科治疗

目的探讨大肠癌肝转移的手术治疗效果。方法对30例大肠癌肝转移病人施行手术切除,结合文献对手术适应证、手术方式以及随访结果进行分析。结果全组无手术死亡。中位生存期25.6个月,1、3、5年生存率分别为89.3%、41.8%和14.5%。结论早期诊断及手术切除是治疗大肠癌肝转移的有效方法。