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。     

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.     

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.     

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.     

慢性顽固性便秘30例手术治疗分析

目的 研究手术治疗慢性便秘的临床价值、手术适应证及其对肠道功能的影响.方法 结肠慢传输型便秘患者25例,结肠慢传输型便秘合并出口梗阻型便秘患者1例,成人巨结肠致便秘患者4例,均行手术治疗.术后随访记录患者排便情况、并发症、生活质量.结果 所有患者术后无严重并发症及死亡.30例患者术后生活质量均得到明显改善,随访6～36个月,术后3个月内大便次数均增多,平均每日4.5次(3～6次),软便;以后大便次数逐渐减少,1年后每日1～3次成形大便,无一例需服止泻剂.术后2例患者出现粘连性肠梗阻,1例术后出现吻合口漏,其他患者均未出现肠梗阻、腹泻、腹痛、排便失禁等并发症.结论 对排便功能障碍患者,有选择性的行结肠次全切除并盲直肠吻合术,近期疗效理想,特别对于慢传输型便秘疗效较好,但长期疗效尚需进一步研究.     

再造回肠储粪袋对全结肠切除术后排便的影响

为观察人工再造回肠储粪袋对结肠慢传输型便秘全结肠切除术后排便的影响,将48例结肠慢传输型便秘患者随机分为试验组和对照组,试验组24例采用全结肠切除后回肠末端造J型储粪袋后与直肠吻合治疗,对照组24例不造人工储粪袋。观察两组患者术后的排便情况。结果显示,试验组较对照组大便不成形例数、水样便例数、排便次数明显减少（P〈0．05）。结果表明,人工储粪袋对结肠慢传输型便秘患者全结肠切除术后排便影响很大,可以明显减少长期腹泻情况,提高患者的生活质量。     

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。     

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 。     

腹腔镜全结肠切除术中超声刀的应用

目的 评价经腹腔镜行全结肠切除术中应用超声刀的安全性和可行性。方法 回顾性分析2002年4月至。2004年5月间应用超声刀进行腹腔镜全结肠(次全)切除术的临床资料。结果 15例患者均为结肠慢传输性便秘，经完全腹腔镜全结肠切除3例，手助腹腔镜结肠次全切除12例。平均手术时间为267min，术中平均失血量147ml。术后排便困难症状均有明显缓解，平均排便为2次／d。结论 在腹腔镜全结肠切除术中应用超声刀分离结肠系膜是安全、有效的方法，但手术时间稍长。     

结肠次全切除逆蠕动盲直吻合术治疗特发性慢传输便秘

目的：评估结肠次全切除伴逆蠕动盲直吻合术治疗特发性慢传输型便秘的疗效。方法：特发性慢传输型便秘患者12例，慢传输型合并出口梗阻型便秘患者1例，行结肠次全切除伴逆蠕动盲直吻合术。所有患者术前排便均为泻药依赖性，平均9d排大便1次。术后随访记录患者排便情况、并发症、生活质量。结果：所有患者术后无严重并发症及死亡。术后1个月每天平均大便次数为2．4次(1～5次)，半液体状大便。术后8个月平均每天大便次数1．6次(0．7～3．5次)，半固体状大便。术后所有患者均不需用止泻药，1例混合型便秘患者仍用泻药外其余患者均未用泻药。13例患者(100％)术后生活质量得到明显改善。术后1例患者出现粘连性小肠梗阻，其余患者未出现腹泻、腹痛、腹部不适等并发症。结论：对部分慢传输便秘患者选择性行结肠次全切除后逆蠕动盲直端端吻合术近期效果理想，但长期疗效需进一步研究。     

Laparoscopic therapy of chronic constipation]

Chronic constipation is a common complaint. Clinical presentation varies with each individual. This study reports the results of laparoscopic therapy in 92 patients with chronic constipation. In two patients conversion was necessary. The majority of patients were female (n = 84, 93.3%). Mean age was 60.3 years (+/- 15.7). In three patients with slow-transit constipation a laparoscopic assisted subtotal colectomy was performed. In patients with outlet obstruction a laparoscopic assisted sigmoid resection was carried out, whereas in 79 a rectopexy with reconstruction of the pouch of douglas was added. In 6 of 8 patients with concomitting diverticulitis an anterior resection was necessary. Mean stay on ICU was 0.5 days. OR time ranged from 100 up to 490 minutes. In 21 patients (23.4%) postoperative complications were observed; however only in 7.8% (n = 7) this lead to additional surgical intervention. The postoperative follow-up is 24 months (6-52 mon). In 76.3% of patients with outlet obstruction and rectal prolapse chronic constipation postoperatively improved or patients felt "symptomfree". In patients with outlet obstruction but without rectal prolapse constipation postoperatively was better in 75.8%. After subtotal colectomy 2 of 3 patients (66%) felt cured after surgery. Careful patients selection by thorough preoperative physiologic testing is mandatory for successful outcome in surgery of chronic constipation. Based on this by laparoscopic surgery same functional results as with conventional open technique could be achieved.     

单孔腹腔镜结肠次全切除联合盲肠直肠逆蠕动吻合术治疗慢传输型便秘

部分慢传输性便秘患者可通过结肠全或次全切除术获得良好临床疗效.传统开腹手术创伤较大,随着微创理念深入开展,腹腔镜辅助或全腹腔镜结肠全或次全切除术逐渐受到临床医师的广泛关注.2014年2-4月第三军医大学大坪医院对2例慢传输型便秘患者施行了单孔腹腔镜结肠次全切除联合盲肠直肠逆蠕动吻合术,近期疗效满意.     

Functional outcomes of two types of subtotal colectomy for slow-transit constipation: ileosigmoidal anastomosis and cecorectal anastomosis

BACKGROUND: Some patients with severe slow-transit constipation may benefit from subtotal colectomy, but there is no consensus on standard operative mode. The aim of the study was to compare the functional outcomes of subtotal colectomy with cecorectal anastomosis (CRA) with those of subtotal colectomy with ileosigmoidal anastomosis (ISA) in patients with severe slow-transit constipation. METHODS: Records of 79 patients who received preoperative investigation to confirm slow transit at our institution from 1989 to 2004 and subsequently received colectomy with CRA (n = 34) or colectomy with ISA (n = 45) were reviewed. The mean follow-up was 2 years (range 1-15). RESULTS: Postoperative defecation frequency increased and symptoms such as bloating and abdominal pain decreased in both groups. More CRA patients than ISA patients experienced persistent constipation and continued using laxatives or enemas at the 12-month follow-up. More ISA patients (93.3%) than CRA patients (73.5%) were satisfied with the procedure, whereas some patients in both groups complained of excessively high stool frequency and fecal incontinence. CONCLUSION: Both CRA and ISA procedures increase the number of bowel movements; however, ISA results in higher defecation frequency, less use of laxatives and enemas, and higher patient satisfaction.     

结肠次全切除联合改良Duhamel术治疗慢性便秘的临床研究

目的探讨结肠次全切除联合改良Duhamel术对慢性混合性便秘的治疗效果。方法对我院2008年6月至2009年1月采用结肠次全切除联合改良Duhamel术治疗的9例慢性混合性便秘病人的临床资料进行回顾性分析。结果所有病人便秘症状缓解,无肛门失禁,近期内无便秘复发。部分病人术后出现直肠刺激症状,尚能耐受。结论结肠次全切除联合改良Duhamel术是治疗慢性混合性便秘的一种有效可行的术式。     

外科治疗顽固性慢传输性便秘的疗效评价

目的:研究顽固性慢传输性便秘（STC）外科治疗方法与结果。方法:回顾分析我院近几年来治疗STC 24例患者的临床资料。结果:18例患者接受全结肠切除术治疗，6例接受结肠次全切除术，其中14例合并有出口梗阻性便秘（OOC）的患者，术前都给予相关手术矫治，手术治愈率95.8％，术后大便次数平均为（3±1.9）次/d。腹胀由术前的75.0％降为12.5％。1例术后便秘症状复发。结论:结肠切除术是治疗STC的理想手术方式，为保证手术取得良好效果，对合并有OOC的患者术前应行积极矫治处理。     

Surgical management for slow-transit constipation

Less than 10% of patients with slow-transit constipation require surgical management after failure of medical treatment. Preoperative clinical, psychological and colorectal routine investigations (ie colonic transit test, anorectal manometry and defecography) are mandatory in order to highly select the patients. To day, the surgical management of slow-transit constipation consists of subtotal colectomy with ileorectal anastomosis, eventually by laparoscopic approach. Although, surgical management improves slow-transit constipation in two thirds of the patients, small bowel obstruction, abdominal pain and constipation recurrence can occur in 25%, 50%, and 10% of the patients respectively.     

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.     

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??Pay attention to the standardized diagnosis and treatment of refractory constipation LI Ning. Department of General Surgery, Nanjing General Hospital of Nanjing Military Command, Affiliated Jinling Hospital of Nanjing University School of Medicine, Nanjing 210002,China
Abstract The primary factors impacting outcomes of patients with refractory constipation include the non-standardization of diagnosis, operative and non-operative therapy. The treatment of refractory constipation should be based on systematic examines and evaluation. After grading and typing the patients according to the cause of the disease, we could then determine the therapeutic regimen and principle. Non-operative therapy is the first choice for refractory constipation, we should use an individual systematic therapy which contains dietary therapy, psychological treatment, biofeedback therapy, optimal stepped medication and regulation of biological metabolism instead of the traditional medicine mainly therapy. Operative therapy is the last choice after the non-operative therapy has failed, and then most of the patients have developed to refractory mixed constipation. The surgery procedure specifically designed for isolated slow-transit constipation or obstructive defecation cannot achieve ideal effect. To treat severe refractory constipation in patients with combined slow-transit constipation and obstructive defecation, a new surgical procedure (named “Jinling procedure” in our hospital) was developed. The Jinling procedure combines subtotal colectomy and side-to-side cecorectal anastomosis, aiming to solve the coexistence of obstructive defecation and slow-transit constipation in one operation. Initial and long term results have been promising. With the development of laparoscopy and the further rationalization of surgical treatment for constipation, the minimally invasive surgery would play an important role in treating constipation.