结肠慢传输型便秘及其合并出口梗阻型便秘的诊治

目的:探讨结肠慢传输型便秘(STC)及合并出口梗阻型便秘(OOC)的诊断和外科治疗。方法:对顽固性便秘的病人根据临床表现结直肠及盆底动力学等检查的结果进行分析诊断。对48例确诊为STC的病人采用结肠切除术治疗,对其中27例伴有OOC的病人于结肠切除术同期或前期采用相应的手术治疗。结果:病理检查:结肠壁内神经丛均有变性。56·3%(27/48)STC患者伴有OOC。术后随访1~5年手术有效率为93·8%。结论:STC的外科治疗应根据结肠慢传输的病变程度、分布范围及是否合并OOC选择适合的手术方案。     

结肠切除直肠悬吊盆底抬高重建术治疗重度混合型便秘的临床分析（附16例报告）

目的探讨结肠慢传输型便秘（STC）合并出口梗阻型便秘（OOC）的外科治疗方法及疗效。方法总结16例混合型便秘手术及随访资料。13例行结肠次全切除逆蠕动盲直吻合＋直肠悬吊、盆底抬高重建术,3例行结肠全切除回直吻合术＋直肠及子宫悬吊、盆底抬高重建术。结果术后无严重并发症,1例患者发生粘连性小肠梗阻。随访1～3年,每天大便次数为2～4次,Wexner失禁评分（4.8±1.6）。7例患者对手术效果满意,9例非常满意。结论结肠（次）全切除、直肠悬吊、盆底抬高重建术是治疗混合型便秘的有效方法。     

腹腔镜与开腹结肠次全切除术（保留回盲部）治疗慢传输型便秘的效果比较

比较腹腔镜与开腹结肠次全切除术（保留回盲部）治疗慢传输型便秘（STC）的效果。回顾性分析2019年1月至2021年12月山东省立第三医院胃肠外科收治的STC患者的临床资料,根据治疗手术方式分为腹腔镜组和开腹组,患者随访至少1年,比较两组患者术前与术后1、3、6、12月Wexner便秘评分、胃肠生活质量评分、排便满意度。共入选59例STC患者,其中腹腔镜组27例,开腹组32例,两组患者年龄、性别比例、便秘病程、Wexner便秘评分等一般情况比较差异无统计学意义（P>0.05）。两组患者均成功行保留回盲部的结肠次全切除术。与开腹组相比较,腹腔镜组术中手术时间较长,术中出血量、术后住院时间、术后并发症发生率及排便满意度方面均优于开腹组（P<0.05）。两组患者术后1年Wexner便秘评分、胃肠生活质量评分、排便满意度较术前均显著改善（P<0.05）。术后1个月及术后3个月,腹腔镜组胃肠生活质量评分、排便满意度均较开腹组高,差异有统计学意义（P<0.05）。腹腔镜下结肠次全切除术（保留回盲部）治疗结肠传输障碍便秘安全、有效,并发症少,患者排便满意度高。     

结肠次全切除术治疗结肠慢传输型便秘45例体会

慢传输型便秘（slow transit constipation,STC）是指由于结肠运动功能迟缓,传输功能减弱而致的便秘。STC首选内科治疗,只有经过严格内科治疗无效的顽固性STC,才考虑手术治疗。在STC手术治疗方法中,结肠次全切除术已被广大外科医师接受并作为治疗STC的标准术式[1]。我院2006年7月至2010年5月采取结肠次全切除术治疗STC共45例,随访1年,均取得了良好的效果。报道如下。     

腹腔镜结肠切除术治疗慢性传输型便秘的临床体会

目的:探讨腹腔镜治疗慢性传输型便秘(slowtransit constipation,STC)的临床效果。方法:回顾分析2006至2009年施行腹腔镜手术治疗23例STC患者的临床资料。8例行全结肠切除术,10例行结肠次全切除术,5例行乙状结肠切除术。结果:22例手术成功,1例因术中出血中转开腹。住院5~11d,平均7d。术后1例并发肠梗阻,经保守治疗不能缓解,再次行开腹手术治愈。随访6~12个月,18例便秘症状明显缓解,大便1~3次/d;3例腹泻,大便4~6次/d;2例轻度便秘复发,大便1次/2~3d。结论:腹腔镜结肠切除术治疗STC安全有效,且住院时间短,患者康复快,切口小,并发症少,腹部外观好,值得推广应用。     

不同术式治疗慢传输型便秘的评价

目的 观察3种外科术式(即结肠全切除、结肠次全切除和结肠部分切除术)在治疗结肠慢传输型便秘中的治疗效果,并初步探讨慢传输型便秘(colon slowly transit constipation,STC)合理的手术治疗方式.方法 回顾性分析2000年3月～2008年1月实施手术的35例患者的临床资料,其中行结肠全切除术者10例,12例行结肠次全切除术,13例行结肠部分切除术.结果 35例患者经过手术后,其排便困难、大便性状、下坠感、频次及腹胀等症状均较手术前有明显改善,结肠全切除术者术后无复发,结肠部分切除术者术后复发率明显高于结肠全切除术.结论 结肠全切除、结肠次全切除和结肠部分切除这3种外科术式对治疗结肠慢传输型便秘均有满意的疗效,但结肠全切除术后患者腹泻发生率高,应根据患者的具体病情选择相应的术式.     

结肠次全切除术治疗慢传输型便秘合并肠梗阻16例

慢传输型便秘（slow transit constipation,STC）属于便秘的一种类型,是一种以结肠通过时间延长和结肠动力下降为特征的顽固性便秘。临床主要表现为每周大便次数减少,便意减少或消失,粪质坚硬,伴有腹胀,症状顽固。严重的STC常合并肠梗阻,易反复发生,最终需手术治疗。2004年12月-2010年12月,青岛市市立医院对24例STC合并肠梗阻患者分别采用选择性结肠肠段切除术和结肠次全切除术．报道如下。     

两种术式治疗合并直肠前突的慢传输型便秘的效果比较

目的比较结肠次全切除联合直肠前壁悬吊术和结肠次全切除联合经阴道修补术治疗合并直肠前突的顽固性慢传输型便秘的疗效。方法回顾性分析2002年1月至2009年1月间收治的32例合并直肠前突的顽固性慢传输型便秘患者临床资料,比较结肠次全切除联合直肠前壁悬吊术(A组)和结肠次全切除术联合经阴道修补术后(B组)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。术中两组的手术时间和出血量差异无统计学意义。术后早期并发症、便秘症状改善程度、Wexner肛门功能评分差异无统计学意义。随访1年后A组的胃肠生活质量指标评分、便秘症状改善度和便秘复发率均好于B组(P0.05)。结论与结肠次全切除术联合经阴道修补术相比,结肠次全切除术联合直肠前壁悬吊术是治疗合并直肠前突的顽固性慢传输型便秘的更有效的手术方法 。     

顽固性便秘合并继发性巨结肠患者围手术期的营养支持

目的 探讨围手术期肠内营养支持对顽固性便秘合并继发性巨结肠的外科治疗预后的影响.方法 回顾性分析2007年6月至2011年6月在我院接受手术治疗的78例顽固性便秘合并继发性巨结肠患者的临床资料.结果 78例患者均经过胃肠减压和全静脉营养支持治疗,34例患者肠道恢复通畅,再行2周的全肠内营养支持后择期手术(肠内营养组,enteral nutrition组).另外44例无法恢复肠道通畅者,未接受肠内营养支持治疗,直接手术(未接受肠内营养组,non-enteral nutrition组).手术方式包括金陵术(结肠次全切除+升结肠-直肠后壁侧侧吻合术)45例、金陵术+末端回肠保护性造口术6例、结肠全切除+末端回肠与直肠后壁侧侧吻合术18例、结肠全切除+末端回肠临时造口术9例.术前接受肠内营养的患者的并发症发生率(肺炎0％vs 11.4％、吻合口瘘0％vs 11.4％、吻合口出血2.9％ vs 18.2％、手术造口率0％vs 34.1％),均明显低于术前未接受肠内营养支持组的患者,2组比较,差异有统计学意义(P＜0.05).术前接受肠内营养组的患者,术后1个月的机体指标(包括体重、去脂体重、蛋白质含量、细胞内液、细胞外液、体重指数等)的改善优于未接受肠内营养组.结论 顽固性便秘合并继发性巨结肠需外科治疗,术前应尽可能恢复肠道功能,行肠内营养支持治疗,可显著降低围手术期并发症发生率.     

外科手术对顽固性便秘并继发性巨结肠的疗效研究

目的：探讨不同手术方式治疗顽固性便秘并继发性巨结肠的疗效。方法回顾性分析2007年6月至2013年1月在南京军区南京总医院全军普通外科研究所接受手术治疗的112例顽固性便秘并发继发性巨结肠患者的临床资料,全组患者便秘病程4～22年,其中74例既往接受过腹部中等以上手术。手术方式：（1）金陵术（结肠次全切除加升结肠-直肠后壁侧侧吻合术）81例,其中24例接受腹腔镜辅助金陵术,18例加末端回肠保护性造口术;（2）结肠全切除加末端回肠与直肠后壁侧侧吻合术18例;（3）结肠全切除加末端回肠临时造口术13例（6个月后行末端回肠与直肠后壁侧侧吻合术）。末端回肠保护性造口在术后6个月予以还纳。结果112例患者手术成功率100％,无手术相关死亡病例。术后出现的并发症包括术后早期腹泻90例（80．4％）、肛门疼痛和排粪不尽22例（19．6％）、尿潴留（去除导尿管后24～48 h内出现）16例（14．2％）、吻合口出血9例（8．0％）、吻合口瘘6例（5．4％）以及肠梗阻15例（13．4％）,除6例肠梗阻患者接受肠粘连松解术后症状缓解外,其余并发症均通过保守治疗恢复良好。术后随访6月,不同术式患者Wexner便秘平均评分为5．8～8．3,与术前21．4～28．7比较,明显改善（P＜0．01）。结论顽固性便秘并继发性巨结肠外科手术治疗效果良好。     

顽固性慢传输性便秘的外科治疗及病因研究

目的研究顽固性慢传输性便秘(STC)的手术治疗结果及肠神经递质变化。方法回顾性分析我院近10年来手术治疗的34例STC病例特点、手术方式及效果,用免疫组织化学方法(免疫组化)研究肠神经递质变化。结果本组患者结肠传输均明显减慢,平均136h,85.3%的患者伴有出口梗阻性便秘(OOC),61.8%有性激素异常。免疫组化研究发现,肠壁内神经丛一氧化氮合酶(NOS)免疫反应阳性增强,血管活性肠肽免疫反应阳性降低。所有患者术后恢复良好,5例术后出现粘连性肠梗阻,1例术后便秘复发。结论外科手术治疗是STC内科综合治疗失败后的最后手段,为保证手术效果,术中应同时处理伴随的OOC;肠神经递质改变可能是STC发病的原因之一。     

结肠次全切除逆蠕动盲肠直肠吻合术治疗慢传输型便秘的远期疗效

目的 评估结肠次全切除、逆蠕动盲肠直肠吻合术治疗特发性慢传输型便秘的远期疗效。方法 对2003年1月至2004年2月14例单纯慢传输型便秘患者和2例慢传输型合并出口梗阻型便秘患者行结肠次全切除、逆蠕动盲肠直肠吻合术。术后随访患者的排便情况、并发症、生活质量及满意度。结果 平均随访期为3年。所有患者术后无严重并发症及死亡。术后1个月每天平均排便4次（3—6次）,半液体状大便。术后3年平均每天排便2次（1—3次）,固体状大便。随访期间所有患者控便能力良好,无大便失禁发生。2例患者出现术后粘连性小肠梗阻。9例患者对手术效果满意,7例非常满意。所有患者生活质量得到明显改善。1例混合型便秘患者术后需间断性使用泻药。结论 对部分慢传输型便秘患者行结肠次全切除后逆蠕动盲肠直肠吻合术效果理想。     

Subtotal Colectomy with Antiperistaltic Cecorectal Anastomosis in the Treatment of Slow-transit Constipation: Long-term Impact on Quality of Life

Background The aim of the study was to evaluate the effectiveness of subtotal colectomy with cecorectal anastomosis (SCCA) in the treatment of slow-transit constipation, not just in terms of symptom resolution but also the overall impact on patients’ quality of life. Methods Between 1991 and 2005, 43 patients underwent SCCA at our institution, 22 for slow-transit constipation (STC) and 21 for other types of colic diffuse disease (non-slow-transit constipation: NSTC), the latter being considered controls. A total of 29 patients (17 affected by STC) were administered a 50-item telephonic questionnaire, including the Gastrointestinal Quality of Life Index (GIQLI), the Wexner constipation and incontinence scale (WC, WI), and individual willingness to repeat the procedure. Questionnaire data and other parameters such as age, sex, length of follow-up, complications, and length of hospital stay were analyzed and compared, in order to evaluate possible correlations between the parameters and their related impact on quality of life, procedural effectiveness in terms of symptomatic regression, qualitative differences related to pathology (constipation versus non-constipation), and surgical approach (laparotomy versus video-laparo-assisted procedure). Results There were no procedure-related deaths in this series (mortality: 0%); however, we found two complications in the STC group (9.1%), one requiring reoperation. The GIQLI mean score for the STC group was 115.5 ± 20.5 (mean score for healthy people 125.8 ± 13), and the WC mean score passed from a preoperative value of 20.3 to a postoperative value of 2.6. Regression analysis revealed a significant correlation between GIQLI and urgency and abdominal pain, and abdominal pain correlated significantly with pathology (STC). A high number of patients (88.2% in STC) expressed a willingness to repeat the procedure given the same preoperative conditions. Conclusions Comparing our results to those of the most homogeneous literature data, SCCA does not appear to be inferior to subtotal colectomy with ileorectal anastomosis (IRA) in terms of therapeutic effectiveness, postoperative mortality and morbidity, or overall impact on quality of life.     

结肠慢传输型便秘合并出口梗阻型便秘手术治疗7例疗效分析

目的 探讨结肠慢传输型便秘(slow transit constipation,STC)合并出口梗阻型便秘(outlet obstructive constipation,OCC)的手术治疗方法及疗效.方法 回顾性分析2008年9月至2010年9月诊治的7例混合型便秘的手术资料.其中5例采用结肠次全切除、逆蠕动盲肠直肠...     

Laparoscopically assisted subtotal colectomy for slow-transit constipation

Background: When medical therapy fails, slow-transit constipation (STC), a condition seen almost exclusively in women, can be treated surgically. The aim of this study was to describe our results with laparoscopically assisted subtotal colectomy (LASC) for STC. Methods: Over a 22-month period, four female patients underwent LASC with ileorectal anastomosis for STC at our hospital. The preoperative workup included clinical assessment, evacuation proctography, rectoanal manometry, and colonic transit measurement. Mobilization of the whole colon and ligation and division of colonic mesenteric vessels with preservation of the omentum were achieved laparoscopically. Through a small Pfannenstiel incision, the colon was removed from the abdomen, leaving a 15-cm rectal stump in situ. The rectal stump was fully mobilized posteriorly, a side-to-end ileorectal anastomosis was fashioned, and the rectal stump was fixed onto the presacral fascia with sutures. Results: The operating time ranged from 150 to 260 min and blood loss was minimal. There were no conversions to open surgery. The postoperative course was uneventful in all patients but one, a 47-year old woman who had transient severe abdominal distension, pain, and frequent small-volume bowel movements. All patients were discharged by the 4th to 10th postoperative day. At 9-month follow-up, all of our patients had normal anorectal function with two to four solid bowel movements per day. Conclusion: Although it is a technically demanding procedure, laparoscopically assisted colectomy for slow-transit constipation, can be achieved safely.     

Is total colectomy the right choice in intractable slow-transit constipation?

BACKGROUND: The aim of the study was to evaluate the functional results of surgical treatment for intractable slow-transit constipation and to establish that the importance of correct diagnosis and type of colon resection (total or segmental) is essential to achieve optimal outcome while minimizing side effects. METHODS: Between 1995 and 2004, of the 450 patients presenting with chronic constipation, we further investigated 33 patients with a diagnosis of slow-transit constipation that had not improved with medical or rehabilitative treatment. Preoperative evaluation included a daily evacuation diary compiled using Wexner score, psychologic assessment, Medical Outcomes Study 36-item Short Form Health Survey (SF-36), radiologic investigation of colonic transit time, enema radiograph, colpo-cysto-defecography, anal manometry, and, in selected patients, colonoscopy and pudendal nerve terminal motor latency. In 15 cases, the cause of constipation was colonic slow-transit (with a mean Wexner score of 22), which was always associated with dolichocolon. The other 18 patients presented outlet obstruction, and, therefore, these results are not included in the present report. The 15 patients with slow-transit constipation were submitted to total laparoscopic colectomy (2), total open colectomy (6), and left laparoscopic hemicolectomy for left colonic slow-transit (7). RESULTS: Mean follow-up was 38 months. All patients except 1 presented improvement in symptoms with daily evacuations (P < .01; mean Wexner score, 6). Furthermore, results of the SF-36 test showed an improvement in the perception of physical pain, and the emotional, psychologic, and general health spheres after surgical treatment. CONCLUSIONS: Meticulous preoperative evaluation of intractable slow-transit constipation may discriminate between the different causes of chronic constipation and thus avoid the well-known "Iceberg syndrome," which is responsible for many treatment failures.     

Comparison of laparoscopic subtotal colectomy with posterior vaginal suspension and laparoscopic subtotal colectomy with transvaginal repair for patients with slow-transit constipation complicated with rectocele: a non-randomized comparative study in a single center

Background

Slow-transit constipation complicated with rectocele is a mixed constipation difficult to treat by surgery. Different hospitals and surgeons may employ different surgical procedures. The present study aims to compare the efficacy of laparoscopic subtotal colectomy (LSC) with posterior vaginal suspension and LSC with transvaginal repair for patients having refractory slow-transit constipation complicated with rectocele.

Methods

This paper is a retrospective study of 64 patients having refractory slow-transit constipation complicated with rectocele. Admitted from January 2002 to December 2012, the 64 patients were non-randomly divided into two groups: patients who underwent LSC with posterior vaginal suspension (Group A, 36 patients) and patients who underwent LSC with transvaginal repair (Group B, 28 patients).

Results

There was no statistically significant difference (P > 0.05) in preoperative general characteristics and Wexner constipation score between Group A and Group B. There was no statistically significant difference (P > 0.05) in operative time and intraoperative blood loss between the two groups. One month after the surgery, there was no statistically significant difference (P > 0.05) in early postoperative complications, constipation recurrence rate, degree of improvement in constipation symptoms, and Wexner constipation score between the two groups. But 1-year follow-up results show that there was statistically significant difference (P < 0.05) in constipation recurrence rate, gastrointestinal quality of life index, the degree of improvement in constipation symptoms, and Wexner constipation score between the two groups.

Conclusion

Compared with the LSC with transvaginal repair, the LSC with posterior vaginal suspension demonstrated better efficacy in treating refractory slow-transit constipation complicated with rectocele.