Individualized Comprehensive Diagnosis And Treatment Of Chronic Constipation Under MDT Model

Objective:To explore the individualized comprehensive diagnosis and treatment of chronic constipation under the multidisciplinary team(MDT)model.Methods:A retrospective study was conducted to collect the data of patients who visited the multi-disciplinary team for constipation in Northern Jiangsu People’s Hospital from July 2019 to December 2021 through the electronic medical record system.According to the MDT chronic constipation diagnosis and treatment process,the patient’s condition was fully evaluated,and the targeted individualized comprehensive treatment was given according to the patient’s condition after the diagnosis was confirmed.Our department is gastrointestinal surgery and the main research task in MDT is to perform surgical treatment on patients with refractory constipation who failed to comprehensive treatment.The laparoscopic NOSES Jinling group was the study group,and the laparoscopic-assisted Jinling group was the control group.The electronic medical record system collected the operation time,intraoperative blood loss,perioperative inflammatory factors,and surgery-related complications.The patients were followed up at 1,3,6,and 12 months after the operation.The gastrointestinal quality of life score(GIQLI),Wexner constipation score,and complete spontaneous bowel movements per week(SCBM)were used to evaluate the effect of surgery.The patients’ satisfaction with the cosmetic effect of the incision was investigated 3 months after the operation.Using IBM SPSS The data satisfying the normal distribution were compared by independent sample t-test,and the data not satisfying the normal distribution were compared by a non-parametric rank sum test.The categorical variables were expressed by proportion(n%),and χ2 test was used for the comparison of Fixed statistical values.Results:All 212 patients were evaluated and diagnosed according to the MDT chronic constipation diagnosis and treatment process,and completed the modified colonic transit test,rectal manometry,pelvic floor electromyography,defecography,and other auxiliary examinations.According to the results of the modified colonic transit test,85 cases(40.1%)were slow transit constipation,18 cases(8.5%)could be initially diagnosed as outlet obstruction constipation,and 26 cases(12.3%)had both colonic slow transit and outlet obstruction,which could be diagnosed as mixed constipation.The remaining 83 patients(39.2%)had no barium residue in the whole digestive tract and could be diagnosed as normal transit constipation.According to the diagnostic criteria of colon morphology,68 cases(32.1%)had normal colon morphology,91 cases(42.9%)had long transverse colon,45 cases(21.2%)had low colonic tension,and 8 cases(3.8%)had splenic flexure syndrome.According to the individualized comprehensive treatment plan,212 patients were treated individually.Among them,151 patients were relieved after non-surgical conservative treatment,23 patients were relieved after general treatment,and 27 patients were relieved after oral lactulose.According to the constipation classification of the remaining 162 patients,we implemented targeted treatment:1)Among the remaining 63 patients with slow transit constipation,20 patients were relieved by switching to prucalopride,15 patients were relieved by lactulose combined with prucalopride,and the remaining 28 patients underwent surgery;2)Among the 17 patients with outlet obstruction,the symptoms of 7 patients were relieved by biofeedback combined with acupuncture or sacral nerve stimulation,and the remaining 10 patients underwent surgery.3)The symptoms of 56 normal transit patients were relieved by oral linaclotide combined with volumetric laxatives if necessary;4)The effect of conservative treatment for 26 patients with mixed constipation was poor.By combining the treatment of slow transit type and outlet obstruction type,only 3 patients’ symptoms were relieved,and the remaining 23 patients underwent surgical treatment.The remaining 61 patients with ineffective or unsatisfactory conservative treatment were successfully treated with surgery,including 35 patients in the study group who underwent laparoscope-assisted Jinling surgery,and 26 patients in the control group who underwent laparoscopic NOSES Jinling surgery.The average operation time of the study group was 281.5±36.0min,and that of the control group was 258.4±26.5min.The operation time of the study group was longer than that of the control group,and the difference between the two groups was statistically significant(Z=-2.835,P=0.005).The mean intraoperative blood loss was 46.3±13.0mL in the study group and 46.7±12.1mL in the control group,with no statistical significance(Z=-0.423,P=0.643).There was no significant difference in the technical levels of TNF-α,CRP,and IL-6 in the study group before operation.TNF-α was 54.4±2.4ng/L in the study group and 62.4±4.9ng/L in the control group on the third day after the operation,which was statistically significant(t=-7.477,P<0.001).On the third day after CRP was 22.7+/-7.0 mg/l,the control group was 34.7+/-5.3 mg/l,have a statistical meaning(t=7.491,P=0.046).On the third day after the operation,IL-6 was 34.7±5.8ng/L in the control group and 51.3±7.0ng/L in the control group,and there was no significant difference(t=-9.693,P=0.149).There were no significant differences in GIQLI score,Wexner constipation score,and SCBM frequency between the two groups before and 1,3,6,and 12 months after surgery(P>0.05).In the study group,21 patients(84%)were satisfied with the cosmetic effect of the incision,4 patients(16%)were relatively satisfied,and no patients were dissatisfied.In the control group,9 patients(25%)were satisfied,25 patients(69.4%)were relatively satisfied,and 2 patients(5.6%)were dissatisfied.There was statistically significant difference in the number of satisfied patients between the two groups(χ2=20.549,P<0.001).Conclusions:(1)Modified colonic transport test is a convenient,economical,safe,and reliable examination method,which can accurately evaluate the colonic transport function and has greater advantages in judging the type of constipation than traditional colonic transport test.In addition,this method can also show the colon morphology and provide a reference for possible subsequent surgery.(2)Both laparoscopic NOSES and laparoscop-assisted NOSES Jinling can effectively and safely solve the problem of constipation.Laparoscopic NOSES Jinling has the advantages of mild inflammatory reaction and good cosmetic effect of abdominal incision without increasing intraoperative blood loss and perioperative complications.(3)The individualized comprehensive diagnosis and treatment mode of chronic constipation under the guidance of MDT can make more efficient and professional decisions for the diagnosis and treatment of chronic constipation,and carry out individualized sequential gradient treatment on the basis of a clear diagnosis of patients,which effectively solves the constipation problem of patients and is worthy of clinical application.