Comparison Of The Efficacy Of Subtotal Colectomy And Total Colectomy In Treating Slow Transit Constipation

Objective:Slow transit constipation is a kind of intractable functional constipation which is slow in the intestinal transit as the main characteristics. With the diet structure of Chinese dietary fiber intake proportion reducing, the life rhythm accelerating, the influence of psychological and social factors, the functional constipation prevalence rising year by year and the slow transit constipation accounted for 45.5%. The symptoms of the disease are stubborn and the cause of the disease yet has no conclusion. And which leading to taking conservative treatment in Digestion Department is the main method of treatment. Surgical intervention is considered only in the Department of internal medicine when conservative treatment is invalid or poor.At present, the operation of the disease are mainly taking the subtotal resection of the colon, the reverse peristalsis blind rectal anastomosis and the total resection of colon, rectal anastomosis. However, the comparison of the two types of surgical treatment, the literature has few reported at home and abroad. This study is to compare the clinical efficacy of the two commonly used methods in the treatment of refractory slow transit constipation, and to provide the best operation method for the treatment of intractable slow transit constipation in the future. Method:Of the 55 patients enrolled in this study from September 2009 to June 2015 Sino-Japanese Friendship Hospital of Jilin University in surgery and followed up with severe slow transit constipation. Patients were divided into two groups of different surgical methods: subtotal colectomy group(27 cases) and colon resection group(28 cases). Then the study retrospectively analyzed and compared the patients undergoing general information, the perioperative stage, postoperative complications, postoperative defecation, recurrent rate of constipation and surgical satisfaction of the former two groups by Outpatient review, telephone surveys, questionnaires and other ways to collect postoperative follow-up. Two groups of patients with clinical data after statistical analysis, summary and comparison of the two groups of patients with clinical efficacy, and then put forward the best way of operation for the treatment of slow transit constipation. Results:The median follow-up period was 32.5 months(6-57 months). There was no significant difference between the two groups of patients in preoperative general information and intraoperative conditions(t<2,P>0.05). The length of stay in the whole colon resection group was longer than that in the whole subtotal colectomy group, the difference was statistically significant between the two groups(t=2.456, P < 0.05). The use of antidiarrheal frequency within two weeks after surgery in the whole colon resection group was significantly higher than in that of subtotal colectomy group, the difference was statistically significant between the two groups(χ2=5.357, P < 0.05). There was no significant difference in the Wexner constipation score between the two groups within 1 years after surgery(t < 2, P > 0.05), but both were significantly lower than preoperative(P < 0.05). The Wexner constipation score of the second year after operation in the whole colon resection group was significantly lower than that of subtotal colectomy group, and the difference was statistically significant(t=-2.91, P < 0.05). During the follow-up period, the number of bowel movements in the whole colon resection group was significantly higher than that in the subtotal colectomy group, the difference was statistically significant(t> 2, P < 0.05).The recurrent rate of constipation in the whole subtotal colectomy group was significantly higher than that of total colectomy group, the difference was statistically significant(t=4.47, P < 0.05). The degree of satisfaction of the second year after operation in the whole colon resection group was significantly higher than that of subtotal colectomy group, and the difference was statistically significant(t=4.67, P < 0.05). Conclusions:1、Total colectomy with ileorectal anastomosis and subtotal colectomy with antiperistaltic cecoproctostomy for the treatment of intractable slow transit constipation have a good effect of surgery, It is an ideal operation method for the treatment of STC.2、Subtotal colectomy with antiperistaltic cecoproctostomy better than total colectomy with ileorectal anastomosis in the short-term curative effect after operation(such as postoperative hospitalization time and the use of antidiarrheal frequency). However, total colectomy with ileorectal anastomosis superior than subtotal colectomy with antiperistaltic cecoproctostomy in terms of long-term efficacy(such as recurrence rate and surgical satisfaction).