Pilot study of subtotal colectomy with antiperistaltic cecoproctostomy for the treatment of chronic slow-transit constipation
Pilot study of subtotal colectomy with antiperistaltic cecoproctostomy for the treatment of chronic slow-transit constipation
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DOI：
10.1007/bf02234608
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发表时间：
2001-10-01
影响因子：
3.9
通讯作者：
Roncoroni, L
中科院分区：
文献类型：
--
作者：
Sarli, L;Costi, R;Roncoroni, L
目的：全结肠切除回肠直肠吻合术治疗结肠无力所致的慢性便秘，因术后腹泻频发，术后肠梗阻发生率高，功能效果欠佳。受严重结肠无力影响的患者接受了结肠次全切除和一种新的反蠕动盲肠吻合术。该研究的目的是评估保留盲肠直肠连接处后的功能结果。方法：采用结肠次全切除加盲肠反蠕动吻合术，对8例女性孤立性结肠无力和2例耻骨直肠肌收缩和结肠无力患者进行手术治疗。在反蠕动盲肠吻合术前，所有10名患者均依赖泻药，平均排便次数为10天；其中8名患者(80%)有腹胀，7名患者(70%)腹胀，3名患者(30%)腹痛。结果：全组无死亡病例，无主要术后并发症。抗蠕动盲肠吻合术后1个月，平均每天排便次数2.2次(1~4次)，半液态大便。一年后，平均每天排便次数1.3次(0.5-3次)，大便坚固；最后一次随访时记录相同结果。虽然没有患者使用止泻药物，但两名耻骨直肠肌反常收缩的患者继续使用泻药，所有10名患者(100%)都报告生活质量良好或有所改善。结论：初步经验表明，盲肠反蠕动吻合术治疗结肠无力是安全有效的。对于患有孤立性结肠惰性的患者，它能迅速并持久地缓解便秘。
PURPOSE: Functional results of total colectomy with ileorectal anastomosis for the treatment of chronic constipation caused by colonic inertia are often considered unsatisfactory because of the frequency of postoperative diarrhea and the high rate of postoperative small-bowel obstruction. Patients affected by severe colonic inertia underwent a subtotal colectomy with a novel antiperistaltic cecorectal anastomosis. The aim of the study was to assess the functional results after preservation of the cecorectal junction. METHODS: Eight females affected by isolated colonic inertia and two females with both paradoxical puborectalis contraction and colonic inertia, of a median age of 40 years, underwent subtotal colectomy with antiperistaltic cecorectal anastomosis. Before antiperistaltic cecorectal anastomosis all ten patients were laxative-dependant, with a mean bowel frequency of ten days; eight of them (80 percent) had distention, seven (70 percent) bloating, and three (30 percent) abdominal pain. RESULTS: There was no mortality or major postoperative morbidity. One month after antiperistaltic cecorectal anastomosis, bowel frequency was a mean of 2.2 (range, 1-4) per day, with a semiliquid stool consistency. After one year, bowel frequency was a mean of 1.3 (range, 0.5-3) per day, with a solid stool consistency; the same results were recorded at last follow-up. Although no patients used antidiarrheal medicine, laxatives continued to be used by both patients with paradoxical puborectalis contraction, All ten (100 percent) of the patients reported a good or improved quality of life. CONCLUSION: This preliminary experience seems to show that antiperistaltic cecorectal anastomosis is safe and effective for patients with colonic inertia. It results in prompt and prolonged relief from constipation for patients with isolated colonic inertia.