Abstract:

Objective:Severe functional constipation (SFC) was a challenging medical problem that might warrant surgery.This study compared stool frequency,postoperative complications and qualityoflife（QOL）outcomes of subtotal colectomy and combined use of subtotal colectomy and modified Duhamel procedure for SFC. Methods:Between June 2004 and July 2006,31 patients were randomized to receive subtotal colectomy (n=10) or combined surgery (n=21).The selection criteria were normal colonoscopy,abnormal colon transit time (CTT) and abnormal dynamic proctography (DPG).The functional outcomes after surgery were assessed by stool frequency and QOL outcomes over one year period. Results:The preoperative clinical manifestations of the two groups were similar.Functional outcomes with score costive gastrointestinal symptoms［(73.6±8.2)%vs(60.3±805)%］,GIQOL index score (107.6±8.2vs92.1±9.6),recurrent constipation rate(9.5% vs 60.0%) for combined use of subtotal colectomy and modified Duhamel procedure were significantly better than that for subtotal colectomy.No statistically significant difference was observed between the two groups for time for recovery of the bowel function,average length of postoperative hospitalization,and the early postoperative complications. Conclusion:Combined use of subtotal colectomy and modified Duhamel procedure for SFC was better GIQOL outcomes.

Key words: severe functional constipation, subtotal colectomy, duhamel procedure

摘要：

目的:前瞻性随机对照观察结肠次全切除联合改良Duhamel术与结肠次全切除术治疗重度功能性便秘(severe functional constipation,SFC)的疗效及并发症。方法:分析南京军区南京总医院2004年6月至2006年7月间31例经过严格非手术治疗后效果欠佳的SFC临床资料，随机分为结肠切除组(n=10)和联合切除组(n=21)，经过对结肠镜、结肠传输试验和排粪造影等检查结果的分析，分别行结肠次全切除和结肠次全切除联合改良Duhamel术治疗。均随访1年以上，对比两组术后近期疗效。结果:两组术前临床资料差异无显著性意义，均手术成功。联合切除组随访1年后胃肠生活质量指标评分［(107.6±8.2)对(92.1±9.6)分］、便秘症状指标改善度［(73.6±8.2)%对(60.3±8.5)%］和便秘复发率(9.5%对60.0%)等方面明显好于结肠切除组。两组术后肛门排气时间、术后平均住院日、术后早期并发症和大便失禁等方面差异无显著性意义。结论:结肠次全切除联合改良Duhamel术治疗SFC较结肠次全切除术对于胃肠生活质量改善更明显，是较为合理、疗效较好的手术方案。

关键词: 重度功能性便秘, 结肠次全切除术, 改良Duhamel术