GI-pill检测支持的腹腔镜下结肠次全切除旋转盲肠与直肠吻合治疗慢传输型便秘的疗效分析
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摘要
目的评价GI-pill消化道压力检测支持的腔镜下结肠次全切除后旋转盲肠与直肠吻合术式治疗慢传输型便秘的疗效。方法选择需行结肠次全切除手术的慢传输型便秘病例31例,以腹腔镜下结肠次全切除、盲肠或升结肠外旋180°后与直肠中段吻合,充分游离残端后固定系膜确保血管不发生扭曲卡压;术前和术后半年GI-pill智能胶囊结合结肠运输试验评价慢传输型便秘的程度,并分析疗效。结果 31例患者均顺利完成手术,术后半年复查GI-pill检测显示胶囊在体时间从(128.81±25.84)h缩短为(25.35±7.91)h,平均收缩压从(8.73±1.58)kPa提高到(12.82±2.15)kPa,生理响应比32.19%提高到56.23%,结肠运输试验耗时从(145.25±13.92)h缩短为(24.57±4.83)h,上述指标在手术前后进行比较,差异均有统计学意义(均P<0.05)。术后,患者总体排便情况及临床症状明显改善,无严重术后腹泻和肠梗阻发生。结论 GI-pill消化道压力检测可较好评价慢传输型便秘程度及疗效;腹腔镜下结肠次全切除术中升盲肠残端向外侧旋转,再与直肠吻合降低了吻合张力和卡压小肠引起术后不完全性小肠梗阻的潜在风险,该术式的改进将令患者获益更多。
Objective To evaluate the Effect of GI-pill Detection-supported Laparoscopic Subtotal Colonctomy with Rotating Cecum and Rectal Anastomosis in the treatment of slow transit constipation. Methods 31 patients with severe slow transit constipation were recruited as study subjects. Patients received total laparoscopic excision of colon, anastomosed with middle rectal with 180 degrees spin outside the cecum and ascending colon. We performed fully residual end after a fixed mesangial to ensure that blood vessels was not distorted preoperative and 6 months postoperative GI-pill capsule combined with colonic transit test were performed to evaluate the treatment efficacy. Results 31 patients successfully completed surgery. The total effective rate at 6 months was 100%. GI-pill capsule in vivo tests decreased with time from(128.81±25.84) h to(25.35±7.91) h. The average systolic blood pressure increased from(8.73±1.58) kPa to(12.82±2.15) kPa. The physiological response increased from 32.34% to 56.12%. The time for colon transit experiment decreased from(145.25±13.92) h to(24.57±4.83) h. Defecation frequency and clinical symptoms improved significantly. There was no serious postoperative diarrhea and intestinal obstruction. Conclusion GI-pill digestive tract pressure test can better evaluate the slow transit constipation severity and curative effect. For serious slow transit constipation, laparoscopic subtotal colonic resection is a good treatment choice. After the outward rotation, cecum and ascending colon anastomosed with middle rectal can reduce the anastomosis tension, and can avoid intestinal obstruction caused by entrapment. It is a useful surgical improvement and has favorable outcomes for patients.
Objective To evaluate the Effect of GI-pill Detection-supported Laparoscopic Subtotal Colonctomy with Rotating Cecum and Rectal Anastomosis in the treatment of slow transit constipation. Methods 31 patients with severe slow transit constipation were recruited as study subjects. Patients received total laparoscopic excision of colon, anastomosed with middle rectal with 180 degrees spin outside the cecum and ascending colon. We performed fully residual end after a fixed mesangial to ensure that blood vessels was not distorted preoperative and 6 months postoperative GI-pill capsule combined with colonic transit test were performed to evaluate the treatment efficacy. Results 31 patients successfully completed surgery. The total effective rate at 6 months was 100%. GI-pill capsule in vivo tests decreased with time from(128.81±25.84) h to(25.35±7.91) h. The average systolic blood pressure increased from(8.73±1.58) kPa to(12.82±2.15) kPa. The physiological response increased from 32.34% to 56.12%. The time for colon transit experiment decreased from(145.25±13.92) h to(24.57±4.83) h. Defecation frequency and clinical symptoms improved significantly. There was no serious postoperative diarrhea and intestinal obstruction. Conclusion GI-pill digestive tract pressure test can better evaluate the slow transit constipation severity and curative effect. For serious slow transit constipation, laparoscopic subtotal colonic resection is a good treatment choice. After the outward rotation, cecum and ascending colon anastomosed with middle rectal can reduce the anastomosis tension, and can avoid intestinal obstruction caused by entrapment. It is a useful surgical improvement and has favorable outcomes for patients.
引文
[1]KOYFMAN S,SWARTZ K,GOLDSTEIN AM,et al.Laparoscopic-Assisted Percutaneous Laparoscopic Cecostomy(LAPEC)in Children and Young Adults[J].J Gastrointest Surg,2017,21(4):676.
[2]DROSSMAN DA.The functional gastrointestinal disorders and the Rome III process[J].Gastroenterology,2006,13(5):1370-1377
[3]王永兵,张根福,姜萍萍,等.胶囊式测压系统在消化道传输功能测定中的初步应用[J].中华普通外科杂志,2008,23(9):722-723.
[4]林仁敬,鲁海燕,何永恒.慢传输型便秘的研究进展[J].世界临床医学,2016,10(21):129.
[5]MUGIE SM,BENNINGA MA,DI LC.Epidemiology of constipation in children and adults:a systematic review.5Best Pract Res Clin Gastroenterol[J].2011,25(1):3-18.
[6]车忠广,朱安龙,朴大勋,等.浅谈慢传输型便秘的外科治疗现状[J].中国医刊,2015,50(1):40-42.
[7]WALD A,SIGURDSSON L.Quality of life in children and adults with constipation[J].Best Part Res Clin Gastroenterol,2011,25(1):19-27.
[8]莫平,崔明,童卫东.结肠运输试验和全结肠腔内测压在慢传输型便秘诊治中的作用[J].中国肛肠病杂志,2009,29(8):14-17.
[9]李宁.重视顽固性便秘外科治疗的术式选择[J].中华胃肠外科杂志,2011,14(12):915-919.
[10]王永兵,张根福,罗芸葆,等.GI-pill胃肠电子胶囊与结肠运输试验联合检查在慢传输便秘中的应用价值[J].中华结直肠疾病电子杂志,2015,4(2):151-156.
[11]AVRAHAM R,PATRICIA AF,MASSARAT Z,et al.Colectomy for slow transit constipation:effective for patients with coexistent obstructed defecation[J].Int J Colorectal Dis,2013(28):841-847.
[12]SOHN G,YU CS,KIM CW,et al.Surgical Outcomes after Total Colectomy lectomy with Ileorectal Anastomosis in Patients with Medically Intractable Slow Transit Constipation[J].J Korean Soc Coloproctol,2011,27(4):180-187.
[2]DROSSMAN DA.The functional gastrointestinal disorders and the Rome III process[J].Gastroenterology,2006,13(5):1370-1377
[3]王永兵,张根福,姜萍萍,等.胶囊式测压系统在消化道传输功能测定中的初步应用[J].中华普通外科杂志,2008,23(9):722-723.
[4]林仁敬,鲁海燕,何永恒.慢传输型便秘的研究进展[J].世界临床医学,2016,10(21):129.
[5]MUGIE SM,BENNINGA MA,DI LC.Epidemiology of constipation in children and adults:a systematic review.5Best Pract Res Clin Gastroenterol[J].2011,25(1):3-18.
[6]车忠广,朱安龙,朴大勋,等.浅谈慢传输型便秘的外科治疗现状[J].中国医刊,2015,50(1):40-42.
[7]WALD A,SIGURDSSON L.Quality of life in children and adults with constipation[J].Best Part Res Clin Gastroenterol,2011,25(1):19-27.
[8]莫平,崔明,童卫东.结肠运输试验和全结肠腔内测压在慢传输型便秘诊治中的作用[J].中国肛肠病杂志,2009,29(8):14-17.
[9]李宁.重视顽固性便秘外科治疗的术式选择[J].中华胃肠外科杂志,2011,14(12):915-919.
[10]王永兵,张根福,罗芸葆,等.GI-pill胃肠电子胶囊与结肠运输试验联合检查在慢传输便秘中的应用价值[J].中华结直肠疾病电子杂志,2015,4(2):151-156.
[11]AVRAHAM R,PATRICIA AF,MASSARAT Z,et al.Colectomy for slow transit constipation:effective for patients with coexistent obstructed defecation[J].Int J Colorectal Dis,2013(28):841-847.
[12]SOHN G,YU CS,KIM CW,et al.Surgical Outcomes after Total Colectomy lectomy with Ileorectal Anastomosis in Patients with Medically Intractable Slow Transit Constipation[J].J Korean Soc Coloproctol,2011,27(4):180-187.