Subtotal colectomy with antiperistaltic cecorectal anastomosis in the treatment of slow-transit constipation: Long-term impact on quality of life
Subtotal colectomy with antiperistaltic cecorectal anastomosis in the treatment of slow-transit constipation: Long-term impact on quality of life
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DOI：
10.1007/s00268-007-9111-6
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发表时间：
2007-08-01
影响因子：
2.6
通讯作者：
Roncoroni, Luigi
中科院分区：
文献类型：
--
作者：
Marchesi, Federico;Sarli, Leopoldo;Roncoroni, Luigi
背景本研究的目的是评价结肠次全切除加盲肠直肠吻合术（SCCA）治疗慢传输型便秘的有效性，不仅从症状缓解方面，而且从对患者生活质量的总体影响方面。方法1991年至2005年，在我院行SCCA的43例患者，22例为慢传输型便秘（STC），21例为其他类型的结肠弥漫性疾病（非慢传输型便秘：NSTC），后者被视为对照。共29例患者（17例STC患者）进行了50项电话问卷调查，包括胃肠道生活质量指数（GIQLI），Wexner便秘和失禁量表（WC，WI），以及个人愿意重复程序。对问卷调查数据和其他参数（如年龄、性别、随访时间、并发症和住院时间）进行分析和比较，以评估参数之间可能的相关性及其对生活质量、症状消退方面的手术有效性、与病理相关的定性差异的相关影响（便秘与非便秘）和手术入路结果本组病例无手术相关死亡（死亡率：0%）;然而，我们发现STC组有2例并发症（9.1%），1例需要再次手术。STC组的GIQLI平均评分为115.5 +/- 20.5（健康人的平均评分为125.8 +/- 13），WC平均评分从术前的20.3变为术后的2.6。回归分析显示GIQLI与尿急和腹痛显著相关，腹痛与病理（STC）显著相关。大量的患者（88.2%在STC）表示愿意重复的程序给予相同的术前conditions.Conclusions比较我们的结果，最同质的文献数据，SCCA并没有出现在治疗效果，术后死亡率和发病率，或对生活质量的总体影响，次全结肠切除与回直肠吻合术（伊拉）。
Background The aim of the study was to evaluate the effectiveness of subtotal colectomy with cecorectal anastomosis (SCCA) in the treatment of slow-transit constipation, not just in terms of symptom resolution but also the overall impact on patients' quality of life.Methods Between 1991 and 2005, 43 patients underwent SCCA at our institution, 22 for slow-transit constipation (STC) and 21 for other types of colic diffuse disease (non-slow-transit constipation: NSTC), the latter being considered controls. A total of 29 patients (17 affected by STC) were administered a 50-item telephonic questionnaire, including the Gastrointestinal Quality of Life Index (GIQLI), the Wexner constipation and incontinence scale (WC, WI), and individual willingness to repeat the procedure. Questionnaire data and other parameters such as age, sex, length of follow-up, complications, and length of hospital stay were analyzed and compared, in order to evaluate possible correlations between the parameters and their related impact on quality of life, procedural effectiveness in terms of symptomatic regression, qualitative differences related to pathology (constipation versus non-constipation), and surgical approach (laparotomy versus video-laparo-assisted procedure).Results There were no procedure-related deaths in this series (mortality: 0%); however, we found two complications in the STC group (9.1%), one requiring reoperation. The GIQLI mean score for the STC group was 115.5 +/- 20.5 (mean score for healthy people 125.8 +/- 13), and the WC mean score passed from a preoperative value of 20.3 to a postoperative value of 2.6. Regression analysis revealed a significant correlation between GIQLI and urgency and abdominal pain, and abdominal pain correlated significantly with pathology (STC). A high number of patients (88.2% in STC) expressed a willingness to repeat the procedure given the same preoperative conditions.Conclusions Comparing our results to those of the most homogeneous literature data, SCCA does not appear to be inferior to subtotal colectomy with ileorectal anastomosis (IRA) in terms of therapeutic effectiveness, postoperative mortality and morbidity, or overall impact on quality of life.