Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Zhengzhou, 450052, China.
Updates Surg. 2023 Jun;75(4):871-880. doi: 10.1007/s13304-023-01458-y. Epub 2023 Mar 14.
To investigate the clinical efficacy of laparoscopic total colectomy with ileorectal anastomosis (TC-IRA) and laparoscopic subtotal colectomy with antiperistaltic cecorectal anastomosis (SC-ACRA) on adults with slow transit constipation (STC). One hundred and three patients with STC were assigned to the TC-IRA group (n = 53) and the SC-ACRA group (n = 50). The clinical data were analyzed. The surgery was successful in all patients (100%). Significantly (P = 0.03) more patients took anti-laxatives during hospitalization in the TC-IRA than the SC-ACRA group (39.62% vs. 20.00%). Abdominal pain and distension was present in 33.96% and 32.00% patients in the TC-IRA and SC-ACRA group, respectively, which decreased insignificantly (P > 0.05) to 18.87% and 18.00% 24 months after surgery, respectively. The postoperative Wexner and gastrointestinal quality of life (GIQLI) scores were not significantly different (P > 0.05) at all times after surgery in both groups. The defecation frequency decreased in both groups, and the average defecation frequency was significantly (P < 0.05) higher in the TC-IRA than the SC-ACRA group (3.91 ± 1.23 vs. 3.14 ± 1.15 times/day) at 3 months. Three months after surgery, significantly (P < 0.05) fewer patients were satisfied with defecation frequency in the TC-IRA than the SC-ACRA group (29 vs. 37 patients), whereas the number of patients who were willing to choose the same procedure again was not significantly (P > 0.05) different between the two groups. The WIS score of patients was significantly (P = 0.035) higher in the TC-IRA than the SC-ACRA group (6 vs. 5) 3 months later. TC-IRA and SC-ACRA are both safe and effective for adult slow transit constipation, and can significantly improve the quality of life of patients. Even though SC-ACRA has better early defecation frequency, postoperative antidiarrheal application and satisfaction, the long-term follow-up effects are similar.
探讨腹腔镜全结肠切除回直肠吻合术（TC-IRA）与腹腔镜结肠次全切除逆蠕动盲直肠吻合术（SC-ACRA）治疗成人慢传输型便秘（STC）的临床疗效。
选择 2017 年 6 月至 2019 年 6 月首都医科大学附属北京世纪坛医院收治的 103 例 STC 患者，根据手术方式不同分为 TC-IRA 组（n=53）和 SC-ACRA 组（n=50）。比较两组患者的一般资料、手术情况、术后并发症、胃肠功能恢复情况、Wexner 便秘评分、胃肠道生活质量评分（GIQLI）、WIS 评分及术后随访情况。
两组患者均顺利完成手术（100%）。TC-IRA 组患者住院期间使用通便药物的比例明显高于 SC-ACRA 组[39.62%（21/53）比 20.00%（10/50）]，差异有统计学意义（P=0.03）。TC-IRA 组和 SC-ACRA 组患者术后分别有 33.96%（18/53）和 32.00%（16/50）发生腹痛腹胀，差异无统计学意义（P>0.05）；术后 24 个月时，两组患者的腹痛腹胀发生率分别降至 18.87%（10/53）和 18.00%（9/50），差异无统计学意义（P>0.05）。两组患者术后 Wexner 评分和 GIQLI 评分比较，差异均无统计学意义（P>0.05）。术后两组患者排便次数均减少，且 TC-IRA 组患者排便次数明显多于 SC-ACRA 组[（3.91±1.23）次/d 比（3.14±1.15）次/d]，差异有统计学意义（P<0.05）。术后 3 个月时，TC-IRA 组患者对排便频率的满意度明显低于 SC-ACRA 组[29.0%（15/53）比 37.0%（19/50）]，差异有统计学意义（P<0.05）；但愿意再次选择相同术式的患者比例差异无统计学意义（P>0.05）。术后 3 个月时，TC-IRA 组患者的 WIS 评分明显高于 SC-ACRA 组[6（4，8）分比 5（3，6）分]，差异有统计学意义（P=0.035）。
TC-IRA 和 SC-ACRA 治疗成人 STC 均安全有效，均可明显改善患者的生活质量，虽然 SC-ACRA 术后早期排便频率、通便药物应用及患者满意度较好，但长期随访效果相似。
