Comparative Study Of Operation Method To Slow Transmissive Constipation

Purpose: Forward-looking design follow-up system and the subjective and objective evaluation standard, through observation, contrast and research on the three operation method of slow both transmissive constipation on STC missile trans it constipation) the efficacy, safety, and find a less postoperative complications, the standard operation for high patient satisfaction for promotion.Methods: Included in 2012, march, 2015-03 treatment of 45 patients with s low both transmissive constipation, randomly assigned into group A: 16 cases of laparoscopic surgical jinling group;Group B: laparoscopic colon resection combined ileum- 14 cases of rectal anastomosis group;Selective group C: laparoscopic colon resection combined appendix- rectal anastomosis group of 15 cases.Through preoperative evaluation inc lude patients’ age, course of the disease, nutritional status.In the form of questionnaire survey Wexner constipation score, gastrointestinal life quality score(GIQLI).Intraoperative and postoperative evaluation inc lude: record total such confinement, such confinement, operative time, postoperative patients with aeration time and the degree of postoperative diarrhea, postoperative complications and disposal methods and healing time.The long-term curative effect evaluation inc ludes: the degree of patients with diarrhea and symptomatic treatment, nutritional status, a questionnaire survey of patients satisfaction, constipation and GIQLI grading.Long-term efficacy evaluation time is: after 3 months, 6 months and 12 months and outpatient follow-up rating.Results: 1.Patients in group A than group B and C group patients’ length of hospital stay, postoperative hospital stay, operation time, aeration time was significantly longer(P < 0.05), postoperative daily stool frequency was significantly increased(P < 0.05).Group B, C groups of patients in hospital stay, postoperative hospital stay, operation time, aeration time no significant difference(P > 0.05), group B patients postoperative patients daily stool frequency was significantly more than group A(P < 0.05). 2. No intestinal obstruction occurred three groups of patients, but three groups of patients in 3 cases incis ion infection or Trocar hole infection.A group of patients with postoperative 1 case of anastomotic bleeding, postoperative blood quantity > 100 m1) within 24 h, the incidence was 6.25%(1/16), gives the non-operative therapy on recovery;Patients in group A in 1 case of anastomotic fistula, postoperative inc idence was 6.25%(1/16), after the double pipe flushing drainage self-healing.Patients of group A compared with group B and C group, the inc idence of patients with gastric paralysis, anastomotic bleeding, and high incidence of anastomotic fistula(P < 0.05).Group C compared with group B patients incis ion infection rate and the inc idence of gastric paralysis and the incidence of anastomotic fistula, anastomotic bleeding, no statistical significance(P > 0.05). 3. The three groups of patients with postoperative clinical symptoms were s ignificantly improved, constipation symptoms of complete remission, constipation score, score < eight points.Preoperative GIQLI score no statistical difference of three groups of patients, postoperative 3 months, 6 months, 12 months GIQLI score significantly higher than that of preoperative(p < 0.05), postoperative 3 months in patients with gastrointestinal life quality s ignificantly better than preoperative.Six months after the first 3 months of GIQLI score significantly increased(p < 0.05), after 6 months and 12 months after there was no significant difference.Three groups of patients with postoperative GIQLI rating of 3, 6, 12 months in group A and group C grade is no significant difference, and significantly higher than that of group B grade, with statistical significance(p < 0.05). 4. Short-term postoperative complications mainly defecation frequency increas ing, but with the extens ion of between, the frequency o f bowel movements gradually reduce, reduce postoperative 3 ~ 6 months to 2 ~ 5 times/day(diarrhea c lassification for level 1).Postoperative 3 months in group A and group B patients with diarrhea classification for level 3, group C classification as secondary diarrhea patients, oral montmorillonite powder treatment can alleviate.After 6 months, 12 months of diarrhea classification in group A and group C level, the group B for the secondary, group B need to be treated as continuous oral montmorillonite powder. 5. Assessment of nutritional status: three groups of patients after 3 months and the average weight of preoperative no significantly difference(p > 0.05);After 6 months, 12 months weight compared with preoperative and postoperative 3 months, three groups of average weight was increased(P < 0.05), the added value of three groups of average weight has no statistical significance(P > 0.05).After 3 months, 6 months, 12 every egg blood, transferrin, albumin, hemoglobin, etc before compared with preoperative were increased, after 6 months and 12 months significantly increased(P < 0.05).After 3 months gradually restored, nutritional status after 6 months back to normal, and there was no obvious change in 12 months.Conclusion: Jinling although have good treatment effect, but surgical trauma, technical difficulty is big, vice injury in the operation, high incidence of complications related to the operation and more serious.All joint ileum and colon resection of rectal anastomosis postoperative incidence of diarrhea and diarrhea degree, high patient satisfaction is not high.Selective colon resection and jinling retained the cecum and the part of ascending colon, the recurrence rate of postoperative constipation is higher, if see in the cecum and ascending colon pathological changes(intestinal wall thickness change, tens ion, pale, insuffic ient blood supply caused colon bag and colon is not obvious or lack of, blind expansion), suggested the whole joint ileum and colon resection of rectal anastomosis.Selective colon resection is safe and effective treatment of slow both transmissive constipation, and less postoperative complications, and patient satisfaction is high.To sum up, selective colectomy is surgery on STC standard operation method is suitable for promotion.