成人结肠冗长症的诊断与外科治疗82例报告.pdfVIP

中华普通外科杂志20o7年l2月第22卷第l2期 Chin J Gen Surg。December 20o7．Vo1．22．No．12 · 905· ． 论著 ． 成人结肠冗长症的诊断与 外科治疗82例报告 杨维良 张新晨 张好刚 许万松 张浩民 王惠良 张建国 【摘要】 目的 总结成人结肠冗长症的诊断与外科治疗经验。方法 对82例成人结肠冗长 症极其主要合并症——顽固性便秘的临床资料进行回顾性分析。 结果 82例中66例(80％)有顽 固性便秘，28例(34％)有腹痛、腹胀，16例(19％)便秘与腹泻交替出现。82例中74例经x线钡剂灌 肠透视，8例于急诊术中确诊。35例为结肠冗长症I型；19例为Ⅱ型；28例为Ⅲ型(其中包括4个节 段结肠冗长即全结肠冗长18例)。82例中行乙状结肠切除32例，右半结肠切除术3例，右半结肠及 横结肠切除4例，横结肠左半及脾曲切除4例，降结肠及乙状结肠切除、将脾曲结肠向下游离与直肠 上端吻合15例，横结肠、降结肠、乙状结肠切除、再将肝曲结肠向下游离与直肠上端吻合6例，全结肠 切除、回肠末端与直肠上端吻合18例。82例术后无肠吻合口漏等严重并发症。术后随访3个月至 4年，随访率为88％(72／82)，疗效满意。 结论 根据顽固性便秘病史和x线钡剂灌肠透视可确诊 成人结肠冗长症，外科手术是治疗成人结肠冗长致顽固性便秘的有效措施。 【关键词】结肠疾病；便秘；诊断；外科治疗 Intractable constipation ~AHIS~]by adult doHchocolon YA G Wet一1／ang，zHA G Xin—chen，zHA G Hao一 ，XU n—song，ZHANG Hao—min，WANG Hui—liang，ZHANG Jian—guo．Department ofSurgery， the SecondAffiliated HosphaZ ofHarbin Medical Un／vers／ty．日 r6 150086．China Corresponding author：YANG Wei—liang。E—mail：wlyang2008@163．COB _ 【Abstract】 objeetive To summarize the diagnosis and surgical treatment for intractable constipation caused by adult dolichocolon． Methods Clinical data of 82 adult dolichocolon cases suffering from intractable constipation were analyzed retrospectively． Results Of the 82 patients．intractable constipation were found in 66 patients(80％)，abdominalgia、abdominal distension in 28 patients(34％) and constipation alternatively witl1 diarrhea in 16 patients(19％)．Diagnosis was established in 74 patients by barium enema while 8 during the emergency operation．Dolichocolon Was divided into 3 types as type I in 35 cases，typeⅡ in 19 and type III in 28，in which tl1ere were 18 cases of total dolichocolon syndrome． Surgery performed including sigmoidectomy(32 patients)，right hemicolectomy(3 patients)，right hemicolon and transvers colon r