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顽固性便秘的外科治疗——术式选择和围手术期处理

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当慢性便秘发展至顽固性便秘阶段时,患者便秘症状重且持续,药物治疗往往效果不佳,因此常需考虑外科手术治疗.顽固性便秘患者的临床表现多样,其基础病理生理改变涉及结直肠和盆底解剖结构异常及功能紊乱,且各不相同.对于采用外科手术治疗顽固性便秘,术前精准分型诊断至关重要,需制订确切有效的手术方案,以避免无针对性的经验性治疗.术后保持长期良好效果的关键在于进行全面而科学的术前评估,以及正确的个体化术式选择.近年来,得益于顽固性便秘基础研究与临床诊疗的进展,以及外科微创技术和围手术期管理水平的提升,手术治疗的安全性和有效性已显著提高.本文综合国内外研究进展与作者的临床经验,重点探讨术前精准评估、术式科学选择以及围手术期肠道微生态治疗等方面的内容,以期为同道临床实践提供参考.
Surgical treatment for intractable constipation:selection of procedure and perioperative management
When chronic constipation develops to the stage of intractable constipation,the symptoms of constipation in patients are severe and persistent,and drug treatment is often ineffective,so surgical treatment is often considered.The clinical manifestations of patients with intractable constipation are variable,and the underlying pathophysiological changes involve various abnormal and dysfunctional anatomical structure of colorectal and pelvic floor,which are different.For the surgical treatment of intractable constipation,accurate preoperative classification diagnosis is very important,and it is necessary to formulate an exact and effective surgical plan to avoid untargeted empirical treatment.The key to maintain long-term good results after surgery is to carry out comprehensive and scientific preoperative evaluation and the correct choice of individual operation.In recent years,thanks to the progress of basic research and clinical diagnosis and treatment of intractable constipation,as well as the improvement of minimally invasive surgical techniques and perioperative management,the safety and effectiveness of surgical treatment have been significantly improved.Based on the research progress at home and abroad and the authors'clinical experience,this paper focuses on the contents of preoperative accurate assessment,scientific selection of surgical methods and perioperative intestinal microecological therapy,so as to provide references for clinical practice in the same field.

Chronic constipationSurgical proceduresPerioperative management

姜军

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东部战区总医院普通外科研究所,南京 210002

慢性便秘 外科手术 围手术期处理

2024

中华胃肠外科杂志
中华医学会,中山大学

中华胃肠外科杂志

CSTPCD北大核心
影响因子:1.764
ISSN:1671-0274
年,卷(期):2024.27(12)