慢传输型便秘结肠次全切除术后盲肠直肠吻合方式的探讨

目的探讨慢传输型便秘行结肠次全切除术后更合理的盲肠直肠吻合方式。 方法对兰州军区兰州总医院连续收治并进行手术治疗的34例STC患者的临床资料进行回顾性分析,男性3例,女性31例;年龄36～75岁,平均60.5岁。所有患者均选择行结肠次全切除盲肠直肠吻合,手术在常规开腹或是腹腔镜辅助下进行,盲肠直肠吻合方式采用回盲瓣对侧的盲肠侧壁与直肠残端进行端侧吻合。 结果传统开腹施行手术18例,腹腔镜辅助手术16例。术后1～3天开始排便,6～20次/d,术后第5-6天时排便次数逐渐减少。22例患者在术后10天时大便次数减少至8次/d以内;10例患者术后出现稀水样便伴肛门疼痛,经口服易蒙停、思密达等对症处理后好转。术后发生吻合口瘘1例、切口感染5例、尿潴留2例、炎性肠梗阻2例。30例患者得到随访2月至8年,大便次数保持在1-6次/d。2例患者7年后诉肛门坠胀,排便不净感。1例患者于术后4.5年时出现不完全性肠梗阻,经保守治疗后痊愈。27例患者术后立即感觉治疗效果满意,占80%;随访过程中,所有患者自觉症状均较术前改善明显,对手术治疗满意。无围手术期死亡。 结论对于确实需要手术治疗的STC患者,结肠次全切除盲直端侧吻合可以作为术式选择之一。     

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

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。     

结肠慢传输型便秘的手术治疗

结肠慢传输型便秘（slow transit constipation，STC）是以结肠运动功能减弱为特征的一类顽固性便秘，表现为粪便在结肠中的传输速度异常减慢，无便意，大便次数明显减少，以往均为单纯的内科保守治疗，对重症者治疗较为棘手且效果不佳。我科自1999年1月至2006年1月对58例STC患者采用了手术治疗，效果良好，现报告如下。     

慢传输型便秘结肠动力学研究

随着社会人口老龄化的趋势 ,饮食结构的改变以及精神心理和社会因素等的影响 ,慢性便秘已成为影响现代人特别是老年人生活质量的重要病症[1] 。但对慢性便秘的发生机制迄今为止并非完全阐明 ,泻剂导致的泻剂性肠病已引起胃肠科医生的关注。本研究通过对结肠慢传输型便秘结肠动力学特点的评估 ,旨在为这类患者的诊断和治疗策略的选择提供理论和实验室依据。一、材料和方法(一 )研究对象 :5 0例功能性慢性便秘病人 (ｃｈｒｏｎｉｃｆｕｎｃｔｉｏｎａｌｃｏｎｓｔｉｐａｔｉｏｎ ,ＣＦＣ)来自我院胃肠动力中心 (1996～1999年 ) ,并符合以下条…     

慢传输型便秘结肠神经病理改变及其临床意义

目的研究慢传输型便秘结肠肌间神经丛的神经丝蛋白和S100蛋白的病理改变,探索结肠动力减弱的原因,为临床治疗提供理论依据.方法采用免疫组织化学方法研究33例结肠慢传输型便秘患者(STC组)和25例非便秘性结肠(对照组)的升结肠、横结肠、降结肠、乙状结肠的肌间神经丛内神经丝蛋白和S-100蛋白的表达,利用计算机图象分析系统作定量分析,并与病程及年龄作直线相关性分析.所得数据用t检验进行统计学处理.结果对照组结肠肌间神经丛内神经丝蛋白和S-100蛋白的含量在各段之间无显著性差别(P>0.05),STC组结肠各段与对照组比较,神经丝蛋白的含量无明显减少(P>0.05),但出现堆积聚集现象,平均光密度值明显高于对照组(P<0.01);S100蛋白的含量及平均光密度值明显高于对照组(P<0.01).神经丝蛋白和S-100蛋白的改变随着病程的延长而增加,二者呈直线相关(P<0.02)结论慢传输型便秘结肠肌间神经丛存在着全结肠性退行性病理改变,表现为神经丝蛋白的堆积聚集和神经间质的增生,且随着病程的延长而加重,这是造成结肠动力减弱的主要原因.提示,手术切除结肠的范围应是全结肠或次全结肠.     

老年慢传输型便秘的手术治疗

目的 探讨慢传输型便秘的手术治疗效果.方法 经少量钡餐法胃肠运输试验确诊为有胃肠道慢传输因素存在的老年便秘患者51例,其中结肠慢传输患者17例,全部行结肠次全切除术;全消化道慢传输患者9例,5例行全结肠切除,4例行包括结肠全切除的联合手术;结直肠混合型患者25例,9例行结肠次全切除,16例行包括结肠次全切除的联合手术.结果 全组治愈44例（86.3%）,好转7例,有效率（治愈＋好转）100%.25例结直肠混合型便秘患者,单纯结肠次全切除和联合手术的治愈率分别是44.4%（4/9）和93.8%（15/16）,两者的差异有统计学意义（P＜0.05）.9例全消化道慢传输型便秘患者,结肠全切除和联合手术的治愈率分别是75%（3/4）和100%（5/5）.两者虽然有差异,但差异无统计学意义.51例中手术后发生肠梗阻3例,切口感染2例,无手术死亡病例.结论 结肠次全切除术或结肠全切除术是治疗慢传输型便秘的有效方法,结肠慢传输患者应选择结肠次全切除术,全消化道慢传输患者应选择全结肠切除术,对合并有盆底异常、直肠排空障碍和出口梗阻的慢传输便秘患者应选择联合手术.结肠部分切除疗效较差,应慎重考虑.     

结肠慢运输型便秘的外科治疗

我院近年来共收治结肠慢运输型便秘（slowtransitconstitpation，STC）24例，行结肠次全切除加盲肠／升结肠－直肠吻合术，效果满意，现报告如下．1临床资料24例患者，男2例，女22例．平均年龄56岁（34岁～68岁）半数以上有腹痛及腹胀，22例无便意，23例开塞露无效，24例均靠服泻剂才能排便，便秘史均＞5a，每次排便时间20min～40min不等．患者入院后均行结肠运输时间测定及排粪造影检查．前者是po20粒X线标记物，5d后有16粒甚至更多残留于左半结肠处，正常时在5d后即应排净或只有4粒残留在左结肠．少数病例行肛管括约肌肌电图、肛肠测压…     

Long-term results of subtotal colectomy with cecorectal anastomosis for isolated colonic inertia

AIM: To evaluate the results of sub total colectomy with cecorectal anastomosis (STC-CRA) for isolated colonic inertia (CI). METHODS: Fourteen patients (mean age 57.5 ± 16.5 year) underwent surgery for isolated CI between January 1986 and December 2002. The mean frequency of bowel motions with the aid of laxatives was 1.2 ± 0.6 per week. All subjects underwent colonoscopy, anorectal manometry, cinedefaecography and colonic transit time (CTT). CI was defined as diffuse markers delay on CTT without evidence of pelvic floor dysfunction. All patients underwent STC- CRA. Long-term follow-up was obtained prospectively by clinical visits between October 2005 and February 2006 at a mean of 10.5 ± 3.6 years (range 5-16 years) during which we considered the number of stool emissions, the presence of abdominal pain or digitations, the use of pain killers, laxatives and/or fibers. Patients were also asked if they were satisfied with the surgery. RESULTS: There was no postoperative mortality. Postoperative complications occurred in 21.4% (3/14). At the end of follow-up, bowel frequency was significantly (P < 0.05) increased to a mean of 4.8 ± 7.5 per day (range 1-30). One patient reported disabling diarrhea. Two patients used laxatives less than three times per month without complaining of what they called constipation. Overall, 78.5% of patients would have chosen surgery again if necessary. CONCLUSION: STC-CRA is feasible and safe in patientswith CI achieving 79% of success at a mean follow- up of 10.5 years. A prospective controlled evaluation is warranted to verify the advantages of this surgical approach in patients with CI.     

Preservation of superior rectal artery in laparoscopically assisted subtotal colectomy with ileorectal anastomosis for slow transit constipation

BACKGROUNDSlow transit constipation (STC) has traditionally been considered as a functional disorder. However, evidence is accumulating that suggests that most of the motility alterations in STC might be of a neuropathic etiology. If the patient does not meet the diagnosis of pelvic outlet obstruction and poorly response to conservative treatment, surgical intervention with subtotal colectomy may be effective. The most unwanted complication of the procedure is anastomotic leakage, however, preservation of the superior rectal artery (SRA) may reduce its incidence.AIMTo evaluate the preservation of the SRA in laparoscopically assisted subtotal colectomy with ileorectal anastomosis in STC patients.METHODSThis was a single-center retrospective observational study. STC was diagnosed after a series of examinations which included a colonic transit test, anal manometry, a balloon expulsion test, and a barium enema. Eligible patients underwent laparoscopically assisted total colectomy with ileorectal anastomosis and were examined between January 2016 and January 2018. The operation time, blood loss, time to first flatus, length of hospital days, and incidence of minor or major complications were recorded.RESULTSA total of 32 patients (mean age, 42.6 years) who had received laparoscopic assisted subtotal colectomy with ileorectal artery anastomosis and preservation of the SRA. All patients were diagnosed with STC after a series of examinations. The mean operative time was 151 min and the mean blood loss was 119 mL. The mean day of first time to flatus was 3.0 d, and the mean hospital stay was 10.6 d. There were no any patients conversions to laparotomy. Post-operative minor complications including 1 wound infection and 1 case of ileus. There was no surgical mortality. No anastomosis leakage was noted in any of the patients.CONCLUSIONLaparoscopically assisted subtotal colectomy with ileorectal anastomosis and preservation of the SRA can significantly improve bowel function with careful patient selection. Sparing the SRA may protect against anastomosis leakage.     

Peptide YY release after colectomy in slow transit constipation

Background: The gut hormone peptide YY is abundant in the colonic mucosa. Circulating PYY inhibits gastrointestinal motility and decreases food intake. The aim was to determine whether colectomy decreases PYY release in patients with slow transit constipation. Methods: Plasma PYY concentrations were measured in 10 patients with slow transit constipation before and 3–24 months after total abdominal colectomy with ileorectal anastomosis, and in 8 healthy controls. A liquid meal was infused intraduodenally to stimulate PYY release. Results: Postprandial PYY significantly (P?Conclusion. Despite removal of a major source of PYY‐secreting cells, colectomy with ileorectal anastomosis does not induce major impairment of PYY release in slow transit constipation.     

Comparison of two types of colectomy in treating slow transit constipation with or without melanosis coli

AIM: To compare the follow-up outcomes of ileosigmoidal anastomosis(ISA) and caecorectal anastomosis(CRA) in patients with slow transit constipation(STC) with or without melanosis coli(MC).METHODS: We collected the clinical data of 48 STC patients with or without MC from May 2002 to May 2007.Twenty-six patients underwent CRA(14 with MC) and 22 cases received ISA(14 with MC).A 3-year postoperative follow-up was conducted.RESULTS: CRA improved the quality of life [evaluated by the gastrointestinal quality of life index(GIQLI)] in patients without MC,but was inferior to ISA in stool frequency and Wexner and GIQLI scores for MC patients.In the CRA group,patients with MC suffered worse outcomes than those without MC.CONCLUSION: CRA is more suitable for STC patients without MC; however,for STC patients with MC,ISA is a better choice.     

Subtotal colectomy with antiperistaltic cecorectal anastomosis

We assessed the functional results achieved with an antiperistaltic end-to-end cecorectal anastomosis (CRA) after subtotal colectomy. A total of 34 patients with colonic cancer, inflammatory bowel disease or chronic constipation were treated with subtotal colectomy and cecorectal anastomosis. The postoperative mortality was nil; no major postoperative complication was registered. At a mean 60-month follow-up (range, 12–92), 32 patients were alive, showed no diarrhea nor incontinence, were completely relieved from previous symptoms and abdominal discomfort, and had a normal diet. In conclusion, subtotal colectomy with end-to-end antiperistaltic CRA seems to have a role in selected cases for the treatment of inflammatory bowel diseases, colon tumors and slow-transit constipation. Received: 8 November 2001 / Accepted: 30 November 2001     

Results of colectomy for severe slow transit constipation

PURPOSE: This study assesses the outcome of a standardized operation performed by two surgeons for severe idiopathic slow transit constipation that was resistant to laxative treatment. METHODS: Fifty-nine consecutive patients, 4 men and 55 women, with a mean age of 42.3 years, underwent colectomy with ileorectal anastomosis. Slow colonic transit was demonstrated in each case. Fifty-two patients were available for follow-up, with median time to follow-up being 42 (range, 3–81) months. RESULTS: Median bowel frequency was 4 per 24 hours. Sixty-nine percent had four or less bowel movements daily. Ten percent used antidiarrheal medication regularly. One patient had a stoma for recurrent severe constipation. Mean continence score was 1.8 (on a scale of 0–20); six patients were incontinent, and four of these six had normal preoperative anal manometry. Fourteen patients (27 percent) had difficulty with rectal evacuation. Preoperative defecating proctography was a poor predictor of postoperative evacuation difficulties. Twenty-seven patients (52 percent) had persisting abdominal pain, but there was a significant improvement in the degree of pain (P <0.00001). Forty-seven patients (90 percent) were satisfied with the outcome of the operation (and would elect to have it done again). Dissatisfied patients had recurrent constipation or diarrhea and incontinence. CONCLUSION: Colectomy with ileorectal anastomosis produces a satisfactory functional outcome in the majority of patients undergoing surgery for severe constipation with proven slow colonic transit.Supported by the Division of Surgery and the Colorectal Research Fund.Read at the meeting of the Royal Australasian College of Surgeons, Perth, Australia, May 1995.     

Hand-assisted laparoscopic total colectomy for slow transit constipation

Purpose Current medical treatments for slow transit constipation (STC) are often ineffective, and total colectomy with ileorectal anastomosis has been the procedure of choice for selected patients with refractory STC. Today, minimally invasive approaches are being utilized in a greater number of procedures as surgeons become more familiar with the techniques involved. The aim of this study was to assess the safety and utility of hand-assisted laparoscopic total colectomy for STC. Method From January 2002 to December 2005, 44 women presented with complaints of intractable constipation and failed to respond to medical treatment. Slow transit constipation was diagnosed after a series of examinations, including a colonic transit test, anal manometry, balloon expulsion test, and barium enema. All eligible patients underwent a hand-assisted laparoscopic total colectomy with ileorectal anastomosis. Main outcome measures included the operative time, conversion to open procedure, blood loss, time to return of flatus, length of postoperative hospital stay, and complications. Result The mean operative time was 197 min (range, 125–295 min). The mean estimated blood loss was 113 ml (range, 100–300 ml). The mean day of first time to flatus was 2 days, and the mean hospital stay was 7.6 days. There was no conversion to an open procedure and no surgical mortality. In the following period, two patients developed intestinal obstruction, which underwent exploratory laparotomy. However, some 39 patients (88.6%) expressed excellent or good in satisfaction. Conclusion Hand-assisted laparoscopic total colectomy could be a safe and efficient technique in the treatment of STC.     

回直肠吻合分流术对泻剂依赖型慢传输便秘大鼠的排便影响

目的:建立泻剂依赖型大鼠慢传输型便秘(STC)模型,完成回肠直肠吻合分流手术,观察该术式对STC大鼠排便的影响,初步探讨其对STC的治疗效果.方法:72只SD大鼠,随机取10只作为正常对照组,其余62只用大黄小剂量递增灌胃造模.造模过程中死亡5只,剩余57只,手术前处死12只作为模型对照组.剩余的45只大鼠,随机35只手术组,10只自然恢复组,测定并比较各组大鼠间胃肠传输时间及粪便干湿质量比.结果:(1)胃肠传输时间(min):正常对照组为341.77±31.89,模型组为398.83±25.17,1 mo恢复组为428.73±36.19,术后1 mo组为183.6±35.96,各组间对比有明显差异(P<0.05);(2)粪便干湿质量(干/湿):正常对照组为0.444±0.048,模型组为0.495±0.053,1 mo恢复组为0.531±0.033,术后10 d测量为0.139±0.061,术后1 mo为0.372±0.058,各组间对比差异显著(P<0.05).结论:回直肠吻合分流术对STC大鼠的胃肠传输时间及粪便性状影响显著,明显改善了便秘大鼠的症状,且术后1 mo较术后10 d腹泻症状明显改观.