4种术式对结肠慢传输型便秘治疗结果比较.doc

4种术式对结肠慢传输型便秘治疗结果比较 　【摘要】 　　目的 探究结肠慢传输型便秘(STC)的有效外科手术治疗方法。方法 回顾性分析73例STC病人的手术治疗情况。结果 行结肠全切除术9例术后均出现短期内腹泻，其中2例为顽固性腹泻；行结肠次全切除术51例术后出现短期内腹泻12例，腹泻率低于结肠全切除术(Plt;0.05)；行盲直肠端侧吻合术9例术后出现短期内腹泻2例，与结肠次全切除术腹泻率差异无显著性，但手术时间和失血量显著减少(Plt;0.01)。随访中发现，行结肠全切除术和盲直肠端侧吻合术的病人未出现便秘复发，行结肠次全切除术51例1例便秘复发；行结肠部分切除术4例中短期内复发3例。结论 结肠全切除、次全切除和盲直肠端侧吻合术治疗STC效果较好，结肠部分切除术的疗效有待进一步研究。 【关键词】 结肠慢传输型便秘 手术治疗 　　【Abstract】 Objective To explore an effective surgical procedure in treating colonic slow transit constipation (STC). Methods Surgery treatment of 73 cases with STC were retrospectively reviewed . Results Short team diarrhea happened in 9 cases who had pancolectomy, 2 cases among them turned to be refractory diarrhea ; Short team diarrhea happened in 12 out of 51 cases who had subtotal colectomy, the incidence rate of diarrhea subtotal colectomy patients was lower than that in patients with pancolectomy(Plt;0.05); Short team diarrhea happened in 2 cases out of 9 who had cecum rectum end-to-side anastomosis ，which was not significantly different compared with that of subtotal colectomy, but the operation duration and blood loss reduced more significantly(Plt;0.01) .The follow up showed no recurrence of constipation in patients who had pancolectomy and rectum end-to-side anastomosis, one recurrence of constipation case in 51 cases with subtotal colectomy; 3 cases out of 4 who had partial resection of colon had recurrence partial resection of colon . Conclusions Pancolectomy 、ubtotal colectomy and rectum end-to-side anastomosis have satisfactory therapeutic effects in treating STC , while for partial resection of colon methods , the therapeutic effects need further evaluation . 　　【Key words】 Slow transit constipation (STC) Colectomy 　　 　　结肠慢传输型便秘(STC)是动力障碍性疾病，是由于结肠传输功能障碍导致的便秘。随着人们生活节奏的加快和饮食结构、饮食习惯的改变，STC逐年增加且出现低龄化趋势。STC的病因尚不完全清楚，虽然借助现代肠道动力学等先进的检查设备对其诊断已比较容易，但治疗策略和方法尚未统一，相当一部分病人尚需采取外科手术治疗［１］。现对本院2004年4月至2006年7月行外科手术治疗的73例STC病人的临床资料进行回顾性分析。 　　 　　1 临床资料 　　1.1 一般资料 本组73例，其中男8例，女65例，年龄18～79岁，平均（57.13±9.31）岁，体重4