摘要目的 探讨金陵术治疗顽固性混合型便秘的适应证、操作技术和疗效.方法 2000年2月至2011年12月,共590例顽固性混合型便秘患者接受金陵术治疗,其中男性103例,女性487例；年龄14～75岁,平均(42±13)岁.手术方式包括腹腔镜手术412例,开腹手术178例.所有病例术前均明确诊断为顽固性混合型便秘,术后均进行随访评估疗效,术后3、6、12、24个月随访率分别为100％、98.1％、95.8％、92.7％.结果 本组患者中无手术相关性死亡病例,术后平均住院时间(12±9)d.术后常见的并发症依次是小肠粘连性梗阻(9.2％)、吻合口出血(8.1％)、吻合口漏(2.9％),均经对症处理痊愈出院.患者胃肠生活质量评分术前为72±9,术后3、6、12和24个月时分别提高至68±11、99±6、105±9和106±9,与术前比较差异均有统计学意义(t＝62.1、-25.1、－126.5、－143.2,P＜0.01)；Wexner便秘评分术前为21.9±4.5,术后3、6、12和24个月时分别降至9.6±2.4、5.9±2.1、4.6±1.9和4.5±1.8,与术前比较差异亦均有统计学意义(t=48.6、61.8、58.2、45.9,P＜0.01).患者术后排便满意率在3、6、12和24个月时分别为77.5％、92.1％、93.0％和94.1％.结论 金陵术为顽固性混合型便秘的外科治疗提供了一个安全有效的术式选择.

abstractsObjective To discuss a new surgical strategy:Jinling procedure (subtotal colectomy combined with modified Duhamel procedure),of which the indications,technical notes and outcomes were analyzed.Methods The 590 patients with refractory slow-transit constipation associated with outlet obstruction was strictly included between February 2000 and December 2011. The patients induded 103 males and 487 females.Their age were 14-75 years (average 42 ± 13).The 412 patients received laparoscopic-assistant Jinling procedure,and 178 patients with open Jinling procedure.The pre- and postoperation data were collected.The follow up rate were 100％,98.1％,95.8％ and 92.7％ at 3,6,12 and 24 months.Results There was no surgery-related death.Mean hospital day was ( 12 ± 9 ) days.Most complications were managed conservatively without significant events. The common complications after surgery were adhesive intestinal obstruction (9.2％ ),anastomosis bleeding ( 8.1％ ) and anastomosis leakage ( 2.9％ ).The gastrointestinal quality of life index score was 72 ± 9 preoperatively and increased to 68 ± 11,99 ± 6,105 ± 9,106 ± 9 at 3,6,12 and 24 month follow-up,respectively ( t =62.1,－ 25.1,－ 126.5,－ 143.2,P ＜0.01 ).The Wexner constipation scale was 21.9 ±4.5 preoperatively and decreased to9.6 ±2.4,5.9 ±2.1,4.6 ± 1.9,4.5 ± 1.8 at 3,6,12 and 24 month follow-up,respectively (t =48.6,61.8,58.2,45.9,P ＜ 0.01 ).The satisfactory rate was 77.5％,92.1％,93.0％ and 94.1％ at 3,6,12,and 24 month follow-up. Conclusions Jinling procedure provides a good surgical option for refractory slow-transit constipation associated with outlet obstruction.