夏楚琦 梁道明

【摘要】 我国成人慢性便秘的发病率逐年上升，对人们生活带来严重困扰。便秘可分为功能性便秘和继发性便秘，其中由结肠传输功能紊乱而导致的慢传输型便秘（slow transit constipation，STC）是功能性便秘最常见的类型。对于长期内科治疗无效的STC患者，外科手术治疗是最后的手段。外科治疗STC的手术发展至今，在全结肠切除或次全切除后，再行回直肠吻合术（ileorectal anastomosis，IRA）、盲肠直肠吻合术（cecorectal anastomosis，CRA）及回肠乙状结肠吻合术（ileosigmoidal anastomosis，ISA）等对治疗STC来说效果较肯定，而近些年发展起来的金陵术、盲肠乙状结肠吻合术（cecosigmoidal anastomosis，CSA）等术式也有较佳疗效的报道。本文针对STC的外科治疗进展做一综述，详细介绍治疗STC的各种手术的手术方式、手术适应证、临床效果和术后并发症，为了解STC外科治疗的现状及进展提供帮助。

【关键词】 便秘 慢传输型便秘 外科治疗 次全结肠切除术 全结肠切除术

Status and Progress of Surgical Treatment of Slow Transit Constipation/XIA Chuqi， LIANG Daoming. //Medical Innovation of China， 2021， 18（35）： -180

[Abstract] The incidence of chronic constipation in Chinese adults is increasing year by year， which brings serious troubles to people’s life. Constipation can be divided into functional constipation and secondary constipation， among which slow transit constipation （STC） caused by colonic transmission dysfunction is the most common type of functional constipation. For STC patients who have failed long-term medical treatment， surgical treatment is the last resort.In terms of the treatment of STC， IRA， CRA， ISA and other surgical procedures have a positive curative effect， and some new surgical procedures such as Jinling surgery and CSA have also been reported to have a good curative effect in some cases. In this paper， the progress of the surgical treatment of STC is reviewed， and the surgical methods， indications， clinical efficacy and postoperative complications of STC surgeries are introduced in detail， so as to provide help for the understanding of the surgical treatment of STC.

[Key words] Constipation Slow transit constipation Surgical treatment Subtotal colectomy Total colectomy

First-author’s address： The Second Affiliated Hospital of Kunming Medical University， Kunming 650101， China

doi：10.3969/j.issn.1674-4985.2021.35.043

隨着人们饮食结构的改变及精神心理和社会因素的影响，慢性便秘的发病率逐年上升，对人类的生活质量构成严重威胁。我国成人慢性便秘的患病率在10%左右[1]。长期便秘易致失眠、烦躁、抑郁、自杀倾向等精神心理障碍，同时可引起厌食、口臭，可诱发肛裂、痔疮、乳腺疾病、结直肠癌等疾病。对于便秘的患者，临床上首选保守治疗，包括饮食和生活方式的调节、药物治疗、生物反馈治疗等，对于经过严格保守治疗无效的患者，手术治疗为最终手段[2]。便秘最常见的分类方法为功能性便秘和继发性便秘，其中由于结肠传输功能紊乱而导致的慢传输型便秘（slow transit constipation，STC）是功能性便秘最常见的类型。……