腹腔镜辅助结肠次全切除在重度功能性便秘治疗中的应用

目的探讨腹腔镜辅助结肠次全切除（laparoscopic assisted subtotal colectomy,LASC）联合改良Duhamel手术治疗重度功能性便秘（severe functional constipation,SFC）的效果。方法2005年6月~2007年10月,我们对100例SFC患者行LASC联合改良Duhamel手术,在腹腔镜下完成全结肠游离,在下腹部做小切口进腹,行保留回盲部的结肠次全切除,升结肠直肠侧侧吻合。结果LASC完成98例,中转开腹2例。98例LASC腹腔镜下手术时间（76±23）min（48~125min）,总手术时间（170±42）min（140~225min）,术中出血量（35±18）ml（10~160ml）。术后肠道功能恢复时间（42±12）h（25~52h）,无切口感染、吻合口漏等并发症。术后1周内,2例轻度脱水,2例不全性小肠梗阻,经保守治疗缓解。96例无并发症者术后住院时间（7.0±1.5）d（5~11d）。术后1年,90例便秘症状均明显缓解（大便次数1~3次/d）,7例腹泻（大便次数4~6次/d）,3例有轻度便秘复发（大便次数2~3d一次）。术后1年胃肠生活质量（GIQOL）指数（109±20）分（满分144分）,而术前仅为（94±23）分。83例对排便频率感到满意。结论LASC联合改良Duhamel手术是治疗SFC的有效方法,LASC创伤小,对机体内环境影响少,患者术后恢复快,并发症少,符合损伤控制的理念,值得推广应用。

Laparoscopic-Assisted Subtotal Colectomy in the Treatment of Severe Functional Constipation

Objective This study was designed to evaluate the effect of laparoscopic-assisted subtotal colectomy （LASC） and modified Duhamel procedure in the treatment of severe functional constipation （ SFC）. Methods From June 2005 to October 2007, 100 cases of SFC were treated by LASC combined with modified Duhamel procedure in our institute. After freed the colon under a laparoscope, we made a small incision in the lower abdomen to perform subtotal colectomy while preserved the ileocecal region. Then a side-to-side eolorectal anastomosis was conducted. Results In this study, 98 cases of LASC were successively completed and 2 cases were converted to open surgery. The operation time of LASC in the 98 cases ranged from 48 to 125 rain [ mean, （76 ± 23） mini, and the total operation time was 140 -225 min[ mean, （170 ± 42） mini. The intraoperative blood loss was 10 - 160 ml [ mean, （35 ± 18） ml ]. In the patients, the intestinal function was recovered within 25 - 52 hours [ mean, （42 ± 12） h ] after the operation; none of them developed postoperative wound infection, anastomotic stoma, or other complications. One week after the operation, 2 of the 100 patients showed mild dehydration, and 2 were diagnosed as having incomplete small bowl obstruction. All of the four were cured by conservative treatments. The other 96 patients who had no complication were discharged from the hospital in 5 - 11 days [ mean, （7.0 ± 1.5） days] postperation. One year later, the symptoms of constipation were significantly alleviated （defecation 1 - 3 times/d） in 90 patients ; 7 cases had various degrees of diarrhea （ defecation 4 - 6 times/d） ; and 3 patients showed recurrence of mild constipation （defecation 1 time/2 - 3 d）. The gastrointestinal quality of life index （GIQOL） determined in 1 year postperation was （109 ± 20） points, which indicated good results compared to （94 ± 23） points before the operation （maximum： 144）. Eightythree cases were satisfied with their frequency of defecation. Conclusions LASC combined with modified Duhamel procedure is an effective method for the treatment of SFC, resulting in less damage, less influence to the internal environment, and quick recovery. The procedure is worth being wildly used.