| ObjectiveTo compare and analyze the clinical efficacy of laparoscopic total colectomy with ileorectal anastomosis and laparoscopic subtotal colectomy with antiperistaltic cecorectal anastomosis in the treatment of adults with slow transit constipation,and provide experience and references for the clinical treatment of adult slow transit constipation.MethodThe clinical data of 103 adult patients with slow transit constipation admitted to the department of Gastrointestinal Surgery of the First Affiliated Hospital of Zhengzhou University from January 2017 to January 2020 were retrospectively analyzed.There were 27 male patients and 76 female patients,with an average age of(50.31 ± 14.56)years old.According to the surgical method,they were divided into TC-IRA group(laparoscopic total colectomy with ileorectal anastomosis,n=53),and SC-ACRA group(laparoscopic subtotal colectomy with antiperistaltic cecorectal anastomosis,n=50).Preoperative general information such as age and gender,surgical indicators such as operation time and intraoperative blood loss,postoperative hospitalization time,postoperative first transanal exhaust or defecation time,and postoperative complications such as intestinal obstruction and fistula were recorded in the two groups.Wexner constipation scale,GIQLI gastrointestinal quality life index,Wexner incontinence scale and defecation satisfaction were used to evaluate the postoperative defecation of patients,and statistical analysis was performed.ResultsAll patients in the two groups completed the operation successfully without conversion to laparotomy.The postoperative follow-up time was 24 months,and no patients were lost to follow-up.(1).There was no significant difference in preoperative general data between the TC-IRA group and the SC-ACRA group.There was no significant difference in the operation time,intraoperative blood loss,postoperative hospital stay,and first postoperative anal exhaust and defecation time between the two groups TC-IRA and SC-ACRA(P>0.05).The proportion of patients taking antidiarrheal drugs after operation in group TC-IRA was 39.62%(21/53)higher than that in group SC-ACRA with 20.00%(10/50),the difference was statistically significant(P=0.030).(2).Complications:short-term postoperative complications in TC-IRA group and SC-ACRA group were 11.32%(6/53)vs 10.0%(5/50),and the difference was not statistically significant(P=0.828).In the.TC-IRA group,there were 7 cases of long-term complicated with intestinal obstruction,and 4 of them were admitted to hospital due to intestinal obstruction after operation.In SC-ACRA group,6 cases were complicated with long-term intestinal obstruction,and 3 were hospitalized after postoperative intestinal obstruction.In the TC-IRA group,preoperative abdominal pain and abdominal distension were 33.96%(18/53),which decreased to 18.87%(10/53)after surgery,the difference was not statistically significant(P>0.05).In the SC-ACRA group,the number of patients with abdominal pain and distention before surgery was 32.00(16/50),which decreased to 18.00%(9/50)after surgery,and the difference was also not statistically significant(P>0.05).(3).The WCS gradually decreased over time,and there was no significant difference in the WCS between the two groups at 3,6,12,and 24 months after surgery(P>0.05).There was an increasing trend,and there was no significant difference between the groups in the corresponding time period(P>0.05).At 3 months after operation,the average defecation frequency in the TC-IRA group was higher than that in the SC-ACRA group(3.91 ± 1.23 times/day vs 3.14±1.15 times/day),and the difference was statistically significant(P<0.05).The satisfaction survey at 3 months after operation showed that the satisfaction rate of the TC-IRA group was higher than that of the SC-ACRA group 54.72%(29/53)vs 74%(37/50),and the difference was statistically significant(P=0.041).There was no statistically significant difference in the satisfaction rate at 6 months,12 months,and 24 months after surgery.When asking patients whether they are still willing to undergo surgery if they re-select,there was no statistical difference between the TC-IRA group and the SC-ACRA group in the number of people who expressed affirmativeness at 3 months,6 months,12 months,and 24 months after surgery significance(P>0.05).The WIS scores of the two groups showed a downward trend after surgery.The WIS score of the TC-IRA group was higher than that of the SC-ACRA group at 3 months after surgery 6(4,8)vs 5(2,6),and the difference was statistically significant.academic significance(P=0.035).The WIS comparison of TC-IRA group and SC-ACRA group at 6 months,12 months and 24 months after operation showed 4(1,5)vs 2(1,4);3(2,4)vs 2(0,3);1(0,2)vs 1(0,2),the difference was not statistically significant(P>0.05).Conclusions1.Laparoscopic total colectomy with ileorectal anastomosis and laparoscopic subtotal colectomy with antiperistaltic cecorectal anastomosis are safe and effective in the treatment of adult slow transit constipation,and can significantly improve the quality of life of patients with constipation.2.The laparoscopic subtotal colectomy with antiperistaltic cecorectal anastomosis group had better early defecation frequency,postoperative antidiarrheal application and satisfaction than the laparoscopic total colectomy with ileorectal anastomosis group,but the long-term follow-up operation effect was similar.3.Surgical treatment should be cautiously selected for patients with slow transit constipation who complain of abdominal pain and bloating. |
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