Department of Surgery, Seoul National University College of Medicine, Seoul 110-744, South Korea.
World J Gastroenterol. 2012 Aug 28;18(32):4441-6. doi: 10.3748/wjg.v18.i32.4441.
To determine long-term outcomes of surgical treatments for patients with constipation and features of colonic pseudo-obstruction.
Consecutive 42 patients who underwent surgery for chronic constipation within the last 13 years were prospectively collected. We identified a subgroup with colonic pseudo-obstruction (CPO) features, with dilatation of the colon proximal to the narrowed transitional zone, in contrast to typical slow-transit constipation (STC), without any dilated colonic segments. The outcomes of surgical treatments for chronic constipation with features of CPO were analyzed and compared with outcomes for STC.
Of the 42 patients who underwent surgery for constipation, 33 patients had CPO with dilatation of the colon proximal to the narrowed transitional zone. There were 16 males and 17 females with a mean age of 51.2 ± 16.1 years. All had symptoms of chronic intestinal obstruction, including abdominal distension, pain, nausea, or vomiting, and the mean duration of symptoms was 67 mo (range: 6-252 mo). Preoperative defecation frequency was 1.5 ± 0.6 times/wk (range: 1-2 times/wk). Thirty-two patients underwent total colectomy, and one patient underwent diverting transverse colostomy. There was no surgery-related mortality. Postoperative histologic examination showed hypoganglionosis or agangliosis in 23 patients and hypoganglionosis combined with visceral neuropathy or myopathy in 10 patients. In contrast, histology of STC group revealed intestinal neuronal dysplasia type B (n = 6) and visceral myopathy (n = 3). Early postoperative complications developed in six patients with CPO; wound infection (n = 3), paralytic ileus (n = 2), and intraabdominal abscess (n = 1). Defecation frequencies 3 mo after surgery improved to 4.2 ± 3.2 times/d (range: 1-15 times/d). Long-term follow-up (median: 39.7 mo) was available in 32 patients; all patients had improvements in constipation symptoms, but two patients needed intermittent medication for management of diarrhea. All 32 patients had distinct improvements in constipation symptoms (with a mean bowel frequency of 3.3 ± 1.3 times/d), social activities, and body mass index (20.5 kg/m(2) to 22.1 kg/m(2)) and were satisfied with the results of their surgical treatment. In comparison with nine patients who underwent colectomy for STC without colon dilatation, those in the CPO group had a lower incidence of small bowel obstructions (0% vs 55.6%, P < 0.01) and less difficulty with long-distance travel (6.7% vs 66.7%, P = 0.007) on long-term follow-up.
Chronic constipation patients with features of CPO caused by narrowed transitional zone in the left colon had favorable outcomes after total colectomy.
确定治疗便秘和结肠假性梗阻特征患者的手术治疗的长期结果。
前瞻性收集过去 13 年内接受慢性便秘手术的连续 42 例患者。我们确定了具有结肠假性梗阻（CPO）特征的亚组，其特征为狭窄过渡区近端结肠扩张，与典型的慢传输性便秘（STC）不同，无任何扩张的结肠段。分析了具有 CPO 特征的慢性便秘手术治疗的结果，并与 STC 的结果进行了比较。
在因便秘接受手术的 42 例患者中，33 例患者的结肠过渡区狭窄近端有结肠扩张。男性 16 例，女性 17 例，平均年龄 51.2±16.1 岁。所有患者均有慢性肠梗阻症状，包括腹胀、疼痛、恶心或呕吐，症状平均持续时间为 67 个月（范围：6-252 个月）。术前排便频率为 1.5±0.6 次/周（范围：1-2 次/周）。32 例患者接受全结肠切除术，1 例患者接受横结肠转流术。无手术相关死亡。术后组织学检查显示 23 例患者存在低神经节细胞症或无神经节细胞症，10 例患者存在低神经节细胞症合并内脏神经病或肌病。相比之下，STC 组的组织学显示 B 型肠神经元发育不良（n=6）和内脏肌病（n=3）。CPO 组的 6 例患者出现早期术后并发症；伤口感染（n=3）、麻痹性肠梗阻（n=2）和腹腔脓肿（n=1）。手术后 3 个月排便频率提高至 4.2±3.2 次/d（范围：1-15 次/d）。32 例患者获得长期随访（中位随访时间：39.7 个月）；所有患者的便秘症状均有改善，但 2 例患者需要间歇性药物治疗以控制腹泻。32 例患者的便秘症状均有明显改善（平均排便频率为 3.3±1.3 次/d），社会活动和体重指数（20.5kg/m2至 22.1kg/m2）均得到改善，对手术治疗效果满意。与 9 例因结肠扩张而未行结肠切除术的 STC 患者相比，CPO 组小肠梗阻的发生率较低（0%比 55.6%，P<0.01），长途旅行困难程度较低（6.7%比 66.7%，P=0.007）。
左半结肠过渡区狭窄引起的慢性便秘伴 CPO 患者行全结肠切除术后预后良好。
