(Jiuyuan District Hospital, Baotou City, Inner Mongolia Baotou 014060)
Xu Liyang, Wang Wenyuan, Han Wenyou, Zhang Ocean, Yu Yisheng
[Abstract]: Objective: To evaluate the efficacy of colonic bypass surgery for colonic weakness. METHODS: Eighty-one patients with colonic incompetence and 39 patients with colonic incompetence combined with outlet obstruction type constipation underwent colonic bypass surgery. All patients had laxative-dependent bowel movements before surgery and had bowel movements once every 5-8 days on average. RESULTS: All patients’ constipation and other symptoms disappeared after surgery without serious complications or death, and defecation was normal two to three months after surgery, with only 2 cases having soft stools 2-3 times a day. Conclusion: Colonic bypass surgery is ideal for treating colonic weakness, but the long-term efficacy needs further study. Xu Liyang, Department of Surgery, Baotou Poverty Alleviation Hospital
【Key words】：Colonic bypass surgery Colon weakness
“Colonic weakness is also called “colonic slow transmission syndrome”, which is characterized by abdominal distension, lack of bowel movement, long intervals between stools (3-20 days), accompanied by symptoms such as irritability, anxiety, insomnia and memory loss. It is one of the most common causes of intractable constipation. At present, there is a new understanding and progress in the diagnosis and treatment of “constipation” at home and abroad, such as the so-called “habitual constipation” in the past, which is found to be more than 85% of “outlet obstruction type” through various modern examination methods. Constipation”, they are due to anatomical or functional abnormalities at the exit and cause constipation, which must be cured through surgical treatment. However, there is no clear standard treatment for “colonic incompetence”. Since 1993, our hospital has been the first to carry out “surgical treatment of outlet obstruction type constipation” in our region, and through continuous in-depth study and research, the cure rate of such patients has reached more than 98%, and in the treatment of intractable constipation caused by colonic incompetence, we have invented “colonic bypass surgery for colonic incompetence The advantages of this operation are small side injury, simple and easy operation, conforming to physiological function, good efficacy and less pain for patients.
Clinical data and methods
There were 81 patients, 13 males and 68 females, aged 23-75 years old, average 41.2 years old, with a history of 5-20 years, average 7.8 years, clinical symptoms: 81 cases had abdominal distension, irritability, fear of meals, no bowel movement, the longest interval between stools was 20 days, the shortest was 3 days, average 5.8 days, all needed laxatives The colon transmission time was measured: 21 cases with delayed transport in the ascending colon, 24 cases with delayed transport in the ascending colon with transverse colon, 13 cases with delayed transport in the transverse colon alone, 12 cases with delayed transport in the descending colon, 9 cases with delayed transport in the descending colon with transverse colon, and 8 cases with delayed transport in the ascending colon with descending colon. Other examinations: 39 cases with rectal mucosal prolapse and rectal prolapse, 18 cases with rectal prolapse and puborectal muscle syndrome.
Methods: Patients took oral intestinal anti-inflammatory drugs three days before surgery, and cleaned and cleansed the bowel twice a day before surgery. The surgery was performed in the horizontal position, with a trans-rectal incision in the right lower abdomen for ascending and transverse colonic anastomosis or ascending and descending colonic anastomosis, and a median incision in the left mid-abdomen for descending colonic anastomosis, with lateral anastomosis of the cecum-transverse colon, cecum-b, cecum-rectum, and transverse-b according to different conditions. –The anastomosis should pass through 2 fingers (about 3-4 cm), and after the anastomosis is completed, the lateral anastomosis near the After the anastomosis is completed, the colon will be ligated with double No. 10 silk thread on 2-3 cm of the end colon anastomosis, and the plasma muscle layer at the ligature line will be buried for one week, and the laparotomy will be completed. After the operation, the colon was treated with fluids for 6 days, and then gradually fed with semi-liquid food, and after 12 days, it was allowed to eat regular food.
Results
All 81 patients were cured. Patients with blind–transverse and transverse–B anastomosis had 2-3 soft stools per day after surgery, and all of them were formed once a day after 20-60 days; blind –Patients with blind – B and blind – rectal anastomosis had 3-5 loose stools per day after surgery and normal defecation after 2-3 months, and only 2 cases had 2-3 soft stools per day. Postoperative abdominal distension and other symptoms all disappeared, and patients were discharged without abdominal pain and other symptoms, and patients were followed up for 2-5 years without recurrence.
Discussion.
Colonic ankylosis is a chronic, primary and functional disorder of intestinal motility and delayed transmission of intestinal contents due to various causes, where “primary” refers to incomplete understanding of its etiology and epidemiology, and “functional” refers to the absence of systemic Functional” refers to the absence of systemic etiology and medications, and the presence of functional abnormalities associated with constipation, except for organic colon pathology by barium enema and colonoscopy, and the presence of functional abnormalities associated with constipation by dynamic examination of the colorectal pelvic floor. Clinically, because the lesion or functional alteration causing constipation is limited to the colon or is predominantly colonic, it is also called colonic slow transmission constipation. We believe that the indications for surgery should be ① a history of severe defecation disorder; ② ineffective after long-term conservative treatment for at least six months and ineffective after regular systemic treatment by colorectal surgery; ③ evidence of definite colonic atelectasis; ④ absence of outlet obstructive disease; ⑤ sufficient tone in the anal canal; ⑥ absence of diffuse bowel dysmotility symptoms and irritable bowel syndrome; and ⑦ a strong demand for surgery from the patient himself. Colorectal bypass has the following advantages: (1) the operation is simple and easy, and the damage is minimal; (2) the colon of the dysfunctional segment is left open and closed, avoiding the large trauma caused by resection of the colon and the occurrence of intestinal obstruction; (3) the cecum and ileocecal valve are preserved, reducing the occurrence of postoperative diarrhea; (4) there is no malignant change in the open colon at 2-5 years of follow-up, so we use colorectal bypass as a routine procedure to resolve colonic anomaly.
[Reference
Meng Ronggui et al, Journal of the Second Military Medical University
1999.11.30;20(11):863_865
Huang Xiankai et al, Journal of the Third Military Medical University
Journal, 2000.05.20;22(5):462_464
Wang Zai-Ping,Chinese Journal of Anorectal Diseases,2001.01.27;21(1:20_21)
Author:Xu Liyang, August 1958, Male, Baotou, B.S., University
Title: Chief Physician
Director of Baotou Anorectal Disease Society.
Speciality: treatment of tumor and anorectal diseases.
Tel: 13848282518