[Efficacy and safety of combined use of subtotal colectomy and modified Duhamel procedure in the surgical treatment of severe functional constipation].
[Efficacy and safety of combined use of subtotal colectomy and modified Duhamel procedure in the surgical treatment of severe functional constipation].
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DOI：
10.3760/cma.j.issn.1671-0274.2007.02.004
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发表时间：
2007-03
影响因子：
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通讯作者：
Jun Jiang;Ning Li;Weiming Zhu;Jie‐shou Li
中科院分区：
文献类型：
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作者：
Jun Jiang;Ning Li;Weiming Zhu;Jie‐shou Li
目的探讨重度功能性便秘（SFC）的理想手术方法。方法回顾性分析2000年9月至2005年4月行结肠次全切除术和改良Duhamel术治疗的50例SFC患者的临床资料。同时对患者的胃肠道生活质量（GIQOL）进行评价。结果50例患者均经保守治疗无效，经结肠镜、结肠通过时间（CTT）、动态直肠造影（DPG）检查发现病变后，行结肠次全切除术及改良Duhamel术。结肠肌萎缩27例（54%），肌间神经丛节细胞减少29例（58%）。手术治疗后平均随访时间为（2.4 ± 1.2）年。术后GIQOL和便秘指数明显改善。50例患者中有44例（88%）对术后排空感到满意。9例患者主诉轻微腹痛，3例腹泻，2例便秘复发，经口服大剂量泻药和胃肠动力药治疗后痊愈。结论改良Duhamel术联合结肠次全切除术是治疗SFC的有效术式。
OBJECTIVE To explore the satisfactory surgical procedure for severe functional constipation (SFC). METHODS The data of 50 SFC patients, undergone subtotal colectomy and modified Duhamel procedure from Sep. 2000 to Apr. 2005, were analyzed retrospectively. Gastrointestinal quality of life (GIQOL) of these patients were also evaluated. RESULTS All the 50 patients failed to respond to conservative treatment and accepted subtotal colectomy and modified Duhamel procedure after finding pathological changes by the examination of colonoscopy, colon transit time (CTT) and dynamic proctography (DPG). Twenty-seven out of 50 cases (54%) showed colonic muscular atrophy and 29 out of 50 cases (58%) showed decreased ganglion cells in myenteric plexuses of colon. The mean follow-up time after surgical treatment was (2.4+/-1.2) years. GIQOL and constipation index improved dramatically after operations. Forty-four out of 50 patients (88%) were satisfied with their postoperative evacuation. Nine patients complained minor abdominal pain,3 patients diarrhea and 2 patients recurrence of constipation, who were healed by the use of bulk-forming laxatives and GI-mobility drugs. CONCLUSION The combination of modified Duhamel procedure and subtotal colectomy is an effective surgical procedure for the treatment of SFC.