慢性功能性便秘的外科治疗分析

[目的]探讨结肠次全切除联合改良Duhamel术与结肠次全切除术治疗慢性功能性便秘(chronicity func-tional constipation,CFC)的临床疗效。[方法]回顾性分析某院自2008年1月～2010年10月期间收治的36例CFC病人,均经保守治疗后没有达到理想效果的患者。将36例患者随机分为对照组即结肠次全切除组14例和治疗组22例结肠次全切除联合改良Duhamel术。两组均进行随访1年以上,对比两组术后疗效及术后随访结果。[结果]两组术后总体疗效比较肛门排气时间,P﹤0.05。便秘症状改善度比较,P﹤0.01,排便次数、住院时间比较P﹥0.05。术后两组不良反应比较患者在腹泻症状、大便失禁、腹痛腹胀及直肠刺激症状、肠梗阻几方面比较,差异均无统计学意义(P﹥0.05)。两组术后1年随访结果表明,患者在便秘症状改善度、排便频率满意度、生活质量满意度、GQOL指标及便秘复发比率相比较,差异均有统计学意义(P﹤0.05,P﹤0.01)。[结论结肠次全切除联合改良Duhamel术治疗CFC比较结肠次全切除术,对于患者总体疗效具有提高作用,对于患者1年后的生活质量比较,在患者症状改善,排便频率及生活质量满意度方面均有显著性效果,且不增加患者的不良反应发生情况,是疗效确切值得临床推广的手术方案。

ANALYSIS OF SURGICAL THERAPY OF CHRONIC FUNCTIONAL CONSTIPATION

[Objective]To explore clinical therapeutic effect of modified Duhamel and subtotal colectomy on CFC.[Methods]We retrospectively analyzed 36 cases who had CFC treated in our department from January 2008 to October 2010.All cases did not get effect in expectant treatment.The 36 cases were randomly divided into 2 groups that 22 cases in the control group were given combined use of subtotal colectomy and modified Duhamel procedure and 14 case in experimental that were given subtotal colectomy.All patients were followed up for over 1 year.[Results]The time of passage of gas by anus,the improvement of constipation symptom were significantly different in the two groups(P﹤0.05,P﹤0.01).There were no significant differences in times of defecation,length of stay,and complications such as diarrhea,encopresis,stomach ache,abdominal distension,irritative symptom of rectum,intestinal obstruction(P﹥0.05).After 1-year follow up,there were significant differences in the improvement of constipation symptom,frequency of defaecation,quality of life,the index of GQOL,recurrence rate of constipation in the two groups(P﹤0.05,P﹤0.01).[Conclusion]Combined use of subtotal colectomy and modified Duhamel procedure for CFC is better for totally therapeutic effect,and has obvious effect in the improvement of constipation symptom,frequency of defaecation and quality of life,which is worthy in clinical application.