摘要
目的总结腹腔镜辅助结肠次全切除联合改良Duhamel术治疗重度功能性便秘(SFC)的近期疗效、手术并发症及相关手术经验。方法回顾性分析2010年3月至2011年8月期间我科行腹腔镜辅助结肠次全切除联合改良Duhamel术治疗的15例经保守治疗无效的SFC患者的临床资料,比较SFC患者术前1 d及术后1个月的胃肠生活质量评分及便秘症状改善情况。结果 15例SFC患者手术均获得成功,手术时间为(247.33±55.10)min,术中出血量为(107.33±45.59)ml,手术切口长度为(8.40±2.41)cm,术后离床活动时间为(2.27±1.28)d,术后肛门排气时间为(2.60±1.89)d,术后排便时间为(2.87±2.50)d,术后进食时间为(3.07±1.16)d,术后住院时间为(12.64±2.37)d。术后3～4 d出现腹泻患者10例,药物控制良好;术后8 d出现肠梗阻1例,经保守治疗痊愈;术后9 d出现吻合口漏并发深部感染患者1例,经保守治疗痊愈。术后1个月胃肠生活质量总评分较术前明显改善〔(121.80±4.72)分比(90.80±7.24)分,P=0.000〕,便秘症状改善度为(0.81±0.56)%。结论从本组有限的病例资料看,腹腔镜辅助结肠次全切除联合改良Duhamel手术治疗SFC近期疗效良好、安全性确切,具有出血少、创伤小、术后恢复快的特点。
Objective To summarize the short-term efficacy, surgery complications, and relative experiences in the management of severe functional constipation （SFC） under laparoscopy-assisted subtotal colectomy combined modified Duhamel procedure. Methods All the data of 15 patients underwent laparoscopy-assisted subtotal colectomy combined modified Duhamel procedure from March 2010 to August 2011 were collected retrospectively, all the patients were diagnosed as SFC and failed to conservative therapy. The postoperative short-term efficacy, complications of surgery, score of gastrointestinal living condition, and improvement degree of defecation were analyzed. Results All 15 procedures achieved success, the operation time was （247. 33±55.10） min, the intraoperative blood loss volume was （107. 33±45. 59） ml, the incision length was （8.40±2.41） cm, the postoperative out of bed activity time was （2. 27± 1.28） d, the postoperative passage of gas by anus time was （2. 60±1.89） d, the postoperative defecation time was （2. 87±2. 50） d, the postoperative foods taken per oral time was （3.07± 1.16） d, the hospital stay was （12.64±2.37） d. Approximately on day 3-4 after operation, 10 patients presented with postoperative diarrhea but were all under control with antidiarrheals efficiently. One patient presented with incomplete bowel obstruction on day 8 after operation and one patient with stomal leakage complicated with deep infection on day 9 after operation, who both recovered under conservative therapy. The score of gastrointestinal living quality on month 1 after operation was significantly higher than that on day 1 before operation （121.80±4. 72 versus 90.80±7.24, P=0. 000）, and the improvement degree of defecation was （0. 81 ±0. 56） %. Conclusions From the limited case informations, the laparoscopy-assisted subtotal colectomy combined modified Duhamel procedure has a certain short-term curative effect in treatment for SFC with the advantages of faster recovery, less bleeding, shorter hospital stay, and fewer complications.
出处
《中国普外基础与临床杂志》
CAS
2013年第2期169-173,共5页
Chinese Journal of Bases and Clinics In General Surgery
