CAJ | 학술논문

目的：探讨回盲部保留长度对腹腔镜结肠次全切除逆蠕动盲肠直肠吻合术治疗慢传输型便秘患者临床疗效的影响。方法连续收集解放军150中心医院全军肛肠外科研究所2007年4月至2011年12月间采用腹腔镜结肠次全切除逆蠕动盲肠直肠吻合术治疗的81例结肠慢传输型便秘患者的临床资料，其中40例回盲部保留10～15 cm（10～15 cm组），41例回盲部保留2～3 cm（2～3 cm组），比较两组患者术前及术后6、12和24月的Wexner便秘评分（WCS）、Wexner肛门失禁评分（ WIS ）、胃肠生活质量指数（ GIQLI ）、腹痛程度数字评分（ NRS ）及腹痛腹胀频率评分。结果所有患者术后均未发生排粪失禁，10～15 cm组和2～3 cm组患者术后6和12月排粪次数比较，差异均无统计学意义（均P＞0．05）。术后2年，2～3 cm组患者钡剂灌肠回盲部排空时间为（17．7±9．5） h，较10～15 cm组（21．2±20．7） h明显缩短（P＝0．011）。两组患者术前WCS、WIS、GIQLI、NRS 和腹痛腹胀频率评分差异均无统计学意义（均 P＞0．05）；术后6、12和24月，两组WCS、GIQLI和腹痛腹胀频率评分以及2～3 cm组的NRS均较术前明显下降（均P＜0．05）；2～3 cm 组各评分优于10～15 cm 组（ P＜0．01和P＜0．05）；而腹胀频率评分两组差异无统计学意义（P＞0．05）。结论腹腔镜结肠次全切除逆蠕动盲肠直肠吻合手术治疗慢传输型便秘安全有效，缩短回盲部保留的长度可以明显改善患者预后，推荐自回盲瓣上缘向上保留2～3 cm结肠。
목적：탐토회맹부보류장도대복강경결장차전절제역연동맹장직장문합술치료만전수형편비환자림상료효적영향。방법련속수집해방군150중심의원전군항장외과연구소2007년4월지2011년12월간채용복강경결장차전절제역연동맹장직장문합술치료적81례결장만전수형편비환자적림상자료，기중40례회맹부보류10～15 cm（10～15 cm조），41례회맹부보류2～3 cm（2～3 cm조），비교량조환자술전급술후6、12화24월적Wexner편비평분（WCS）、Wexner항문실금평분（ WIS ）、위장생활질량지수（ GIQLI ）、복통정도수자평분（ NRS ）급복통복창빈솔평분。결과소유환자술후균미발생배분실금，10～15 cm조화2～3 cm조환자술후6화12월배분차수비교，차이균무통계학의의（균P＞0．05）。술후2년，2～3 cm조환자패제관장회맹부배공시간위（17．7±9．5） h，교10～15 cm조（21．2±20．7） h명현축단（P＝0．011）。량조환자술전WCS、WIS、GIQLI、NRS 화복통복창빈솔평분차이균무통계학의의（균 P＞0．05）；술후6、12화24월，량조WCS、GIQLI화복통복창빈솔평분이급2～3 cm조적NRS균교술전명현하강（균P＜0．05）；2～3 cm 조각평분우우10～15 cm 조（ P＜0．01화P＜0．05）；이복창빈솔평분량조차이무통계학의의（P＞0．05）。결론복강경결장차전절제역연동맹장직장문합수술치료만전수형편비안전유효，축단회맹부보류적장도가이명현개선환자예후，추천자회맹판상연향상보류2～3 cm결장。
Objective To investigate the influence of length of preserved ileocecum on the efficacy of laparoscopic subtotal colectomy antiperistaltic cecorectal anastomosis (LSCACRA) in treating slow transit constipation (STC). Methods Clinical data of 81 STC patients who received LSCACRA between April 2007 And December 2011 in the 150th Center Hospital of PLA were continuously collected. Patients were divided into two groups: 10 cm to 15 cm ascending colon preserved above ileocecal junction (10-15 cm group, n=41), and 2 cm to 3 cm ascending colon preserved above ileocecal junction (2-3 cm group, n =40). The Wexner constipation scale (WCS), Wexner incontinence scale (WIS), gastrointestinal quality of life index (GIQLI), abdominal pain intensity scale (NRS), abdominal pain frequency scale and abdominal bloating frequency scale in the two groups were determined and compared before and 6, 12, 24 months after operation. Results No postoperative incontinence was found in all the patients. There were no significant differences in evacuation frequency between two groups at 6th and 12th month after surgery (all P>0.05). Two years after operation, barium enema emptying time examination revealed 2-3 cm group was (17.7 ±9.5) h, which was remarkably shorter than (21.2±20.7) h in 10-15 cm group(P=0.011). The WCS, GIQLI, NRS and abdominal pain frequency scale of two groups were improved obviously at 6th, 12th and 24th month after surgery (all P<0.01). Above parameters in 2-3 cm group were superior to 10-15 cm group (all P<0.01), but abdominal bloating frequency scale was not significantly different between the two groups (P>0.05). As compared with before operation, NRS in 2-3 cm group 6, 12, 24 months after operation reduced remarkably(all P<0.01), but did not improve obviously in 10-15 cm group(P>0.05). Conlusion The shorter length of ascending colon preserved above ileocecal junction can improve the efficacy of LSCACRA in the treatment of STC and the prognosis of patients. Two to three cm length of ascending colon preserved above the ileocecal junction should be recommended.