Li Ning, Jiang Jun, Ding Wei-wei, Feng Xiao-bo, Liu Jian-lei, Hu Xiong-hui, Yao An-long, Zhu Wei-ming, Li Jie-shou
Department of General Surgery, Nanjing General Hospital of Nanjing Military Command, Institute of People's Liberation Army for General Surgery, the Clinical College of the Nanjing University Medical School, China.
Zhonghua Wai Ke Za Zhi. 2012 Jun;50(6):509-13.
To discuss a new surgical strategy: Jinling procedure (subtotal colectomy combined with modified Duhamel procedure), of which the indications, technical notes and outcomes were analyzed.
The 590 patients with refractory slow-transit constipation associated with outlet obstruction was strictly included between February 2000 and December 2011. The patients included 103 males and 487 females. Their age were 14-75 years (average 42 ± 13). The 412 patients received laparoscopic-assistant Jinling procedure, and 178 patients with open Jinling procedure. The pre- and post-operation data were collected. The follow up rate were 100%, 98.1%, 95.8% and 92.7% at 3, 6, 12 and 24 months.
There was no surgery-related death. Mean hospital day was (12 ± 9) days. Most complications were managed conservatively without significant events. The common complications after surgery were adhesive intestinal obstruction (9.2%), anastomosis bleeding (8.1%) and anastomosis leakage (2.9%). The gastrointestinal quality of life index score was 72 ± 9 preoperatively and increased to 68 ± 11, 99 ± 6, 105 ± 9, 106 ± 9 at 3, 6, 12 and 24 month follow-up, respectively (t = 62.1, -25.1, -126.5, -143.2, P < 0.01). The Wexner constipation scale was 21.9 ± 4.5 preoperatively and decreased to 9.6 ± 2.4, 5.9 ± 2.1, 4.6 ± 1.9, 4.5 ± 1.8 at 3, 6, 12 and 24 month follow-up, respectively (t = 48.6, 61.8, 58.2, 45.9, P < 0.01). The satisfactory rate was 77.5%, 92.1%, 93.0% and 94.1% at 3, 6, 12, and 24 month follow-up.
Jinling procedure provides a good surgical option for refractory slow-transit constipation associated with outlet obstruction.
探讨一种新的手术策略——金陵术式（全结肠次全切除联合改良杜氏手术），并分析其适应证、技术要点及手术效果。
严格纳入2000年2月至2011年12月间590例伴有出口梗阻的难治性慢传输型便秘患者。其中男性103例，女性487例。年龄14 - 75岁（平均42±13岁）。412例行腹腔镜辅助金陵术式，178例行开放金陵术式。收集手术前后数据。3、6、12和24个月的随访率分别为100%、98.1%、95.8%和92.7%。
无手术相关死亡。平均住院天数为（12±9）天。多数并发症经保守治疗后无严重不良事件。术后常见并发症为粘连性肠梗阻（9.2%）、吻合口出血（8.1%）和吻合口漏（2.9%）。术前胃肠道生活质量指数评分为72±9，在3、6、12和24个月随访时分别升至68±11、99±6、105±9、106±9（t = 62.1、-25.1、-126.5、-143.2，P < 0.01）。术前Wexner便秘量表评分为21.9±4.5，在3、6、12和24个月随访时分别降至9.6±2.4、5.9±2.1、4.6±1.9、4.5±1.8（t = 48.6、61.8、58.2、45.9，P < 0.01）。3、6、12和24个月随访时的满意率分别为77.5%、92.1%、93.0%和94.1%。
金陵术式为难治性慢传输型便秘合并出口梗阻提供了一种良好的手术选择。
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