Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, People's Republic of China.
Dis Colon Rectum. 2013 Jan;56(1):103-12. doi: 10.1097/DCR.0b013e318273a182.
Surgery is indicated for chronic constipation refractory to conservative therapy. The treatment of combined slow-transit constipation and obstructive defecation is controversial.
The aim of the study is to describe the Jinling procedure and examine safety, effectiveness, and quality of life over 4 years of follow-up.
The study is a retrospective review of prospectively gathered data in a patient registry database.
This investigation was conducted at a tertiary-care gastroenterology surgical center in China.
The study included 117 consecutive patients with slow-transit constipation combined with obstructive defecation treated between January 2005 and December 2007.
The Jinling procedure modifies the classic procedure of subtotal colectomy with colorectal anastomosis by adding a new side-to-side cecorectal anastomosis to solve the coexistence of obstructive defecation and slow-transit constipation in one operation.
We measured morbidity and mortality rates, Wexner constipation scores, and Gastrointestinal Quality of Life Index at baseline and after 1, 6, 12, 24, 36 and 48 months of follow-up.
A total of 117 patients underwent the Jinling procedure, which was laparoscopically assisted in 56 patients (47.9%) and an open procedure in 61 patients (52.1%). Of the total, 72 patients (61.5%) had undergone previous surgical intervention without improvement. A total of 28 complications and adverse events were reported in 117 procedures, giving an overall morbidity rate of 23.9%; 23 patients (19.7%) had 1 or more events. Most complications were managed conservatively. A significant reduction in Wexner constipation score was observed from baseline (mean, 21.9) to 1 month (mean, 9.8), and the reduction was maintained at 48 months (mean 5.1; p < 0.001). Compared with baseline, significant overall improvements were also seen in gastrointestinal quality of life at 12, 24, and 48 months of follow-up (p < 0.01).
This study did not include a comparison group.
Our clinical practice demonstrates that Jinling procedure is safe and effective for refractory slow-transit constipation associated with obstructive defecation, with minimal major complications, significant improvement of quality of life, and a high satisfaction rate after 4-year follow up.
手术适用于对保守治疗无反应的慢性便秘。对于合并慢传输型便秘和出口梗阻型便秘的治疗存在争议。
本研究旨在描述金陵术式，并检查其在 4 年随访期间的安全性、有效性和生活质量。
本研究是一项对前瞻性收集的患者注册数据库数据的回顾性研究。
本研究在中国的一家三级保健胃肠外科中心进行。
本研究纳入了 2005 年 1 月至 2007 年 12 月期间接受治疗的 117 例慢传输型便秘合并出口梗阻型便秘的患者。
金陵术式通过增加一种新的侧侧盲肠直肠吻合术来修改经典的次全结肠切除术加结直肠吻合术，以在一次手术中解决出口梗阻型便秘和慢传输型便秘并存的问题。
我们在基线时和随访 1、6、12、24、36 和 48 个月时测量了发病率和死亡率、Wexner 便秘评分和胃肠道生活质量指数。
共有 117 例患者接受了金陵术式，其中 56 例（47.9%）采用腹腔镜辅助，61 例（52.1%）采用开放手术。其中 72 例（61.5%）患者之前曾接受过手术治疗，但无改善。117 例手术中共有 28 例出现并发症和不良事件，总发病率为 23.9%；23 例（19.7%）有 1 次或多次事件。大多数并发症均采用保守治疗。Wexner 便秘评分从基线时（平均 21.9）到 1 个月时（平均 9.8）显著降低，且在 48 个月时仍保持（平均 5.1；p<0.001）。与基线相比，在 12、24 和 48 个月的随访时，胃肠道生活质量也有显著的整体改善（p<0.01）。
本研究未包括对照组。
我们的临床实践表明，金陵术式治疗难治性慢传输型便秘合并出口梗阻型便秘是安全有效的，其主要并发症发生率低，生活质量显著改善，4 年随访后满意度高。
