Ding Weiwei, Jiang Jun, Feng Xiaobo, Yao Anlong, Wang Lin, Li Jieshou, Li Ning
Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, China.
Arch Med Sci. 2014 Dec 22;10(6):1129-34. doi: 10.5114/aoms.2014.47824.
The treatment of slow-transit constipation combined with outlet obstruction is controversial. This study introduced a new surgical strategy, subtotal colectomy combined with a modified Duhamel procedure (Jinling procedure), of which the safety and satisfactory rate were examined.
Ninety patients with refractory slow-transit constipation associated with outlet obstruction were consecutively included between Jan 2010 and Dec 2010. All underwent the laparoscopic-assisted Jinling procedure, which added a new side-to-side anastomosis to the colorectal posterior anastomosis after subtotal colectomy. The pre- and post-operative data were collected.
There was no surgery-related death. A total of 39 complications and adverse events were reported in 22 patients (morbidity rate of 24.4%). Most complications were managed conservatively without significant events. The satisfactory rate was 93.1% at 6-month follow-up.
The Jinling procedure is safe for refractory slow-transit constipation associated with outlet obstruction, with minimal major complications and a high satisfaction rate. However, this procedure requires rigorous preoperative examination, exquisite surgical and laparoscopic techniques and excellent perioperative management. The pelvic floor, especially the presacral space, is damaged, and therefore it may be unsalvageable if severe complications, such as anastomosis leakage or ischemia, occur.
慢传输型便秘合并出口梗阻的治疗存在争议。本研究介绍了一种新的手术策略，即结肠次全切除术联合改良杜哈梅尔手术（金陵术），并对其安全性和满意率进行了评估。
2010年1月至2010年12月连续纳入90例难治性慢传输型便秘合并出口梗阻患者。所有患者均接受腹腔镜辅助金陵术，该手术在结肠次全切除术后的结直肠后壁吻合基础上增加了一种新的侧侧吻合。收集术前和术后数据。
无手术相关死亡。22例患者共报告39例并发症和不良事件（发病率为24.4%）。大多数并发症经保守治疗后无严重后果。6个月随访时满意率为93.1%。
金陵术治疗难治性慢传输型便秘合并出口梗阻安全，主要并发症少，满意率高。然而，该手术需要严格的术前检查、精湛的手术和腹腔镜技术以及良好的围手术期管理。盆底尤其是骶前间隙会受到损伤，因此如果发生严重并发症，如吻合口漏或缺血，可能无法挽救。
