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。

Surgical treatment for refractory slow transit constipation and its etiology

Objective To evaluate the outcome of colectomy for refractory slow transit constipation (STC) and study the changes of colonic nervous transferring substances. Methods Clinicopathologic data including colon transit, defecography, colonscope, sex hormones. Of 34 patients with refractory STC, which underwent colectomy during recent ten years, were studied, Vasoactive intestinal peptide(VIP) and NO synthetase were examined by immunohistochemistry. All patients were followed up. Results Colonic transit time ranged from 96 to 240 hours, with a mean time of 136 hours. 85 3% (29/34) of patients were accompanied with obstructive outlet constipation (OOC). 61 8% (21/34) showed abnormal sex hormones. Most patients were satisfied with the results of their operation, except one case with recurrence. Moreover, a higher NOS and lower VIP positive neuron density were found at the colonic myenteric plexus. Conclusions Colectomy possesses a satisfactory functional outcome for the patients with refractory slow transit constipation, failing in comprehensive internal treatment. OOC should be treated simultaneously. The changes of VIP and NOS may be one of the causes of STC.