摘要
目的探讨腹腔镜直肠前固定术(LVR)治疗合并重度盆底结构异常出口梗阻型便秘(OD)的远期疗效。方法采用回顾性队列研究方法。收集2014年6月至2020年8月上海交通大学医学院附属仁济医院收治的31例合并重度盆底结构异常OD患者的临床资料;男6例,女25例;年龄为59(32~81)岁。患者行经腹入路LVR。观察指标:(1)克利夫兰便秘评分(CCCS)。(2)OD典型症状严重程度。(3)便秘特异性生命质量量表评分。采用电话及门诊方式进行随访,由专职人员进行,通过门诊面谈或手机填写问卷星小程序进行便秘症状及生命质量评估。随访时间截至2021年10月。计量资料以M(范围)表示,手术前后比较采用Wilcoxon符号秩检验法。结果(1)CCCS:31例患者为首次行LVR,随访时间为61.8(11.0~87.0)个月。22例患者便秘症状得到改善。31例患者CCCS从术前的15.8(8.0~26.0)分降低至随访截止时间的10.7(2.0~20.0)分,患者手术前后比较,差异有统计学意义(Z=-3.98,P<0.05)。(2)OD典型症状严重程度:31例患者术前OD典型症状严重程度(排便频率、排便费力感、排便不尽感、腹胀或腹痛、每次排便时间、每日排便失败次数、人工辅助通便)评分分别为2.9(1.0~4.0)分、3.0(1.0~4.0)分、1.9(0~3.0)分、0.5(0~3.0)分、2.6(2.0~4.0)分、2.0(0~4.0)分、0.9(0~2.0)分;术后上述指标分别为1.7(0~4.0)分、1.6(0~4.0)分、1.2(0~4.0)分、0.3(0~3.0)分、1.7(0~3.0)分、1.4(0~3.0)分、0.7(0~2.0)分;患者前6项指标手术前后比较,差异均有统计学意义(Z=-3.38,-3.80,-2.54,-2.31,-3.64,-2.75,P<0.05);人工辅助通便手术前后比较,差异无统计学意义(Z=-1.31,P>0.05)。(3)便秘特异性生命质量量表评分:31例患者术前躯体不适、满意度、焦虑和关切、心理不适评分分别为2.3(1.0~4.0)分、3.2(1.0~4.8)分、2.2(0.6~4.0)分、1.8(0.4~3.9)分,术后上述指标分别为1.6(0~4.0)分、2.3(0~4.0)分、1.7(0~4.0)分、1.3(0~4.0)分;患者上述指标手术前后比�
Objective To investigate the long-term outcomes of laparoscopic ventral rectopexy(LVR)for obstructive defecation with overt pelvic structural abnormalities.Methods The retrospective cohort study was conducted.The clinical data of 31 obstructive defecation patients with overt pelvic structural abnormalities who were admitted to the Renji Hospital of Shanghai Jiaotong University School of Medicine from June 2014 to August 2020 were collected.There were 6 males and 25 females,aged 59(range,32-81)years.All 31 patients underwent LVR through transabdominal approach.Observation indicators:(1)the Cleveland clinic constipation score(CCCS);(2)severity of obstructive defecation;(3)patients assessment of constipation quality of life(PAC-QoL).Follow-up was conducted using telephone interview and outpatient examination up to October 2021.One professional researcher assessed the constipation symptoms and quality of life of patients through outpatient interview or mobile software platform of Questionnaire Star.Measurement data with skewed distribution were represented as M(range),and comparison before and after operation was conducted using the Wilcoxon sign rank test.Results(1)The CCCS.All 31 patients underwent LVR for the first time and were followed up for 61.8(range,11.0-87.0)months.The constipation symptoms of the 22 patients were improved.The CCCS of the 31 patients before surgery and at the last follow-up time were 15.8(range,8.0-26.0)and 10.7(range,2.0-20.0),respectively,showing a significant difference(Z=-3.98,P<0.05).(2)Severity of obstructive defecation.The severity scores of frequency of bowel movements,difficult of bowel movements,sensation of incomplete defecation,abdominal distension or pain,time of each bowel movements,daily unsuccessful times of defecation,artificial assisted defecation for the 31 patients were 2.9(range,1.0-4.0),3.0(range,1.0-4.0),1.9(range,0-3.0),0.5(range,0-3.0),2.6(range,2.0-4.0),2.0(range,0-4.0),0.9(range,0-2.0)before surgery,versus 1.7(range,0-4.0),1.6(range,0-4.0),1.2(range,0-4.0),0.3(ran
作者
曹冬兴
王震华
张晔
李玮祎
王婕
王晓辉
曹景恺
吴广宇
崔喆
Cao Dongxing;Wang Zhenhua;Zhang Ye;Li Weiyi;Wang Jie;Wang Xiaohui;Cao Jingkai;Wu Guangyu;Cui Zhe(Department of Gastrointestinal Surgery,Renji Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200127,China;Department of Gastroenterology and Hepatology,Renji Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200127,China;Department of General Surgery,Baoshan Branch of Renji Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200444,China;Shanghai Jiaotong University School of Medicine,Shanghai 200025,China;Depart-ment of Radiology,Renji Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200127,China)
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2022年第6期796-801,共6页
Chinese Journal of Digestive Surgery
基金
上海市2022年度“科技创新行动计划”生物医药科技项目(22S31903500)
上海市宝山区科学技术委员会科技创新专项资金项目(19-E-30)
上海交通大学医学院附属仁济医院宝山分院医学重点专科建设(rbzdzk-2019-003)。
关键词
便秘
出口梗阻型
腹腔镜直肠前固定术
克利夫兰便秘评分
主观症状
便秘特异性生命质量
Constipation
Obstructed defecation
Laparoscopic ventral rectopexy
Cle-veland clinic constipation score
Subjective symptom
Constipation quality of life
