直肠瓣挂线结扎术治疗出口梗阻型便秘8例疗效观察

目的 探讨出口梗阻型便秘的手术治疗效果.方法 对8例出口梗阻型便秘患者实行应用直肠瓣挂线结扎术,观察手术疗效、并发症.结果 手术均一次成功,平均手术时间15 min,平均住院3 d,无严重并发症,有效缓解便秘症状.结论 直肠瓣挂线结扎术治疗出口梗阻型便秘,效果可靠,操作简单,术后痛苦小,并发症少.     

腔镜切割缝合器经肛直肠切除术治疗直肠前突的临床研究

直肠前突是临床上常见的引起出口梗阻型便秘的疾病之一。其中，中、重度直肠前突导致的出口梗阻型便秘保守治疗效果多不理想，需行手术治疗，手术方式较多，     

直肠前突与出口梗阻型便秘关系的探讨

一般认为,直肠前突的解剖结构性改变是常见的便秘原因.应用外科手术解决直肠前突治疗便秘的临床实践表明,术后复发令手术治疗效果不理想.本研究分析2009年7月至2010年8月在浙江中医大学附属第二医院便秘专科门诊就诊的44例便秘患者的临床资料,旨在探讨直肠前突与便秘类型的关系,从而为直肠前突和便秘的治疗策略提供参考.     

直肠前突的手术治疗进展

直肠前突（rectocele,RC）是指排便时直肠前壁和阴道后壁突向阴道,引起的一系列以排便困难、排便不尽感等为主要临床表现的疾病,严重者需手助排便,是出口梗阻型便秘的常见原因之一,属于中医“便秘”、“脾约”的范畴。治疗中重度直肠前突手术效果较好,本文主要对RC的手术治疗进展做一系统回顾。1经肛门手术     

肛门后方切开加改良Block修补术治疗直肠前突型便秘

目的探讨直肠前突型便秘的手术治疗效果。方法回顾性分析采用肛门后方切开加改良Block修补术治疗82例直肠前突型便秘的疗效。结果本组82例中采用肛门后方切开加改良Block修补术治疗直肠前突型便秘,手术总有效率为96%,其中痊愈率为67%,显效率为18%,有效率为11%。本组病例平均住院(18.8±4.8)d,无1例出现手术并发症。术后随访1～4年无便秘复发和大便失禁。结论该术式具有手术疗效确切、手术简便等特点,同时可于手术中一并处理并发的肛门疾病,可避免术后肛门狭窄。     

改良Block手术治疗直肠前突型便秘36例疗效观察

为观察改良Block手术治疗直肠前突型便秘的临床疗效,采用改良Block手术治疗直肠前突型便秘36例,结果一次性手术治愈34例,二次手术治愈2例,治愈率为100％。结果表明,改良Block手术治疗直肠前突型便秘疗效满意,手术的关键在于正确寻找荷包缝合点,正确处理直肠前突的凹陷,彻底消灭薄弱区。术后保持排便通畅,对防止复发有重要意义。     

腹腔镜下盆底抬高及直肠悬吊治疗出口梗阻型便秘的疗效观察

目的评价腹腔镜下盆底抬高及直肠悬吊治疗出口梗阻型便秘的临床效果。方法回顾性分析2016年11月至2017年6月本院收治的18例慢性出口梗阻型便秘患者临床资料,所有患者均采用腹腔镜下盆底抬高及直肠悬吊手术治疗。记录手术相关情况,比较手术前后临床评分(包括便秘评分、伴随症状评分)、排粪造影征象及其结果。结果 18例患者均顺利完成手术,平均住院时间为(8.39±2.35)d,术后均未出现手术相关并发症、创面均完全愈合。术后骶直分离、直肠折曲、直肠黏膜内套、直肠前突征象检出率较术前减少,差异均有统计学意义(均P0.05)。手术前后,便秘评分、伴随症状评分差异均有统计学意义,乙耻距及骶直间距差异均有统计学意义(均P0.05)。结论腹腔镜下盆底抬高及直肠悬吊治疗出口梗阻型便秘可取得较为理想的临床疗效,其对于改善盆腔入口梗阻情况收效良好。     

特发性便秘197例临床分析

目的探讨特发性便秘的治疗。方法手术治疗特发性便秘１９７例,其中慢传输型便秘２４例,出口梗阻型便秘１７３例,后者包括直肠内套叠７５例,直肠粘膜脱垂５７例,耻骨直肠肌痉挛２５例,直肠前膨出１６例。慢传输型便秘２４例,行结肠次全切除术２０例,行左半结肠切除术４例。采用硬化剂注射治疗直肠粘膜脱垂５４例、直肠内套叠２３例。直肠粘膜缩缝术治疗直肠粘膜脱垂３例。改良式Ｏｒ’ｓ直肠悬吊治疗直肠内套叠５２例,其中加行乙状结肠切除术３１例,加行结肠次全切除术５例,女患者加行子宫悬吊３２例。直肠前膨出行直肠修补１６例。耻骨直肠肌痉挛２５例均采用生物反馈治疗。结果慢传输型便秘痊愈１００％（２４／２４）。直肠粘膜脱垂痊愈７９％（４５／５７）,好转２０％（１１／５７）,无效２％（１／５７）。直肠内套叠痊愈６３％（４７／７５）,好转２９％（２２／７５）,无效８％（６／７５）。直肠前膨出痊愈６９％（１１／１６）,好转３１％（５／１６）。耻骨直肠肌痉挛好转７２％（１８／２５）,无效２８％（７／２５）。结论慢传输型便秘手术治疗效果较好,而出口梗阻型便秘的疗效还有待进一步提高。     

PPH治疗出口梗阻型便秘的临床效果评价

为探讨PPH治疗出口梗阻型便秘的临床效果,回顾性分析PPH治疗出口梗阻型便秘患者400例的临床资料,其中直肠黏膜内脱垂型320例,直肠前突型80例。术后患者平均随访1年,复查排粪造影,评估手术疗效。结果显示,术后治愈392例,好转6例,无效2例,治愈率98．0％,有效率99．5％。结果表明,PPH治疗直肠前突型和直肠黏膜内脱垂型的出口梗阻型便秘,创伤小,恢复快,疗效肯定,并发症少。     

女性便秘的防治

女性便秘发生率高于男性与女性的身体解剖特点、生理特性与心理因素密切相关，女性便秘的自我治疗应重在预防，增加多纤维的饮食和增加户外的运动量是最好的自我治疗，女性便秘的手术治疗应慎重，本文介绍了直肠前突的规范性的手术操作的测定标准，直肠前突修补加耻骨直肠肌切断术增加治愈率的研究；提出了耻骨直肠肌切断术适应证的一些看法。     

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??The controversy and common understanding in surgical treament of constipation WANG Zhen-jun. Department of General Surery, Beijing Chaoyang Hospital, Beijing 100043, China
Abstrct The value of surgical treatment of constipation is based on the accurate diagnosis and correct procedure selected. Colectomy is suitable for slow-transit constipation and proved valuable. Rectocele and mucosal prolapse can be treated by surgical repair by anal??vaginal approach??and by PPH,STARRprocedure, the value of such treatment await more studies and longer follow-up.     

便秘的外科治疗

分析形成便秘的原因,对慢传输型便秘、出口梗阻型便秘和混合型便秘的原因、临床表现、手术适应证以及外科治疗手段进行了重点分析,强调了外科治疗便秘需要严格把握手术适应证,采取适当的术式,才能取得满意的疗效.     

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便秘病因众多,异质性大,缺乏统一准确的检查手段和诊断标准,导致相关的高质量的循证医学依据匮乏,使得便秘的手术治疗存在很多争议。手术治疗可以提高部分便秘病人的生活质量,但是复发率高、并发症多,而且现有的检查手段还很难预测手术的治疗效果。所以,应当非常严格把握手术治疗便秘的适应证。对便秘进行进一步的分类,进而开展大样本、多中心的前瞻性研究,才是解决手术治疗便秘各种争议的根本途径。     

全结肠气钡双重排粪造影的临床应用

目的评价全结肠气钡双重排粪造影能否作为综合诊断便秘患者有价值的影像参考依据。方法利用数字x线胃肠机对260便秘患者进行全结肠气钡双重排粪造影。结果全结肠气钡双重排粪造影诊断出升结肠冗长12例，横结肠冗长8例，降结肠冗长16例，乙状结肠冗长62例，直肠前突59例。其中，结肠冗长合并乙状结肠癌3例，结肠冗长合并降结肠癌2例，结肠冗长合并横结肠癌2例，结肠冗长合并升结肠癌1例。结论全结肠气钡双重排粪造影可一次性了解结肠病变和排粪障碍现状，是一个综合性诊断顽固性便秘的合理方法。     

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...     

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.     

Neuromodulation for constipation and fecal incontinence

The evidence is consistent with permanent SNM substantially improving continence in patients with severe fecal incontinence resistant to medical treatment. This treatment has been used in patients in whom a major surgical intervention would normally have been the next stage in treatment and the option of a minimally invasive treatment, with the added advantage of testing before definitive implantation, has the potential to have a major impact on this patient group. The results of the early case series examining the use of SNM for constipation are encouraging. Patients who have failed maximal medical treatment for constipation pose considerable clinical difficulties, with current surgical treatments requiring a bowel resection or stoma formation. If SNM proves to be of benefit to a proportion of these patients, this will be of considerable importance in terms of their future treatment options. Fecal incontinence and idiopathic constipation are both conditions in which conservative treatment is the mainstay of treatment in most cases,but for a small proportion surgical intervention is warranted. The surgical procedures available,however, have a considerable invasive component with often little guarantee of symptom resolution. SNM is becoming more widely used for patients with fecal incontinence as series sizes get larger and follow-up longer. Its potential benefit in constipation has been shown in pilot studies but larger trials are still required.     

改良Block修补术治疗直肠前突型便秘63例体会

目的 探讨改良Block修补术治疗直肠前突型便秘的疗效.方法 回顾性分析2006年5月至2010年6月采用改良Block修补术治疗的63例直肠前突型便秘病人的临床效果.结果 术后随访6个月,病人经改良Block修补术治疗后痊愈34例、显效18例、有效11例.无并发症,疗效满意.结论 改良Block修补术是治疗直肠前突型...     

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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.     

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。