摘要目的 评价金陵术治疗混合型顽固性便秘的有效性与安全性.方法 2000年2月至2011年6月,南京军区南京总医院普通外科共收治顽固性便秘患者614例,对其中符合混合型便秘诊断及手术指征的554例患者施行创新设计的金陵术治疗.通过收集术前临床基本情况、术中情况及术后并发症等指标进行回顾性研究.采用胃肠生活质量评分、Wexner便秘评分和满意度3项指标来进行术后长期随访以评估手术效果.结果 全组未出现手术相关性死亡.围手术期出现排粪频次增多,24.5％的患者有短时排尿困难,其他并发症包括小肠梗阻(9.6％)、吻合口出血(8.1％)、吻合口瘘(3.1％)、性功能障碍(3.1％)和切口感染(3.1％),均经对症处理或保守治疗恢复.截至2011年8月,术后3、6、12和24个月的随访率分别为100％、88.8％、75.1％和56.3％.胃肠生活质量术前评分为(78.1±9.4)分,术后3个月暂时升高至(92.0±9.5)分,但随后分别在术后6个月[(48.4±14.1)分]、12个月[(21.0±4.3)分]和24个月[(20.0±3.4)分]的随访中显示持续下降,与术前比较,差异均有统计学意义(P＜0.01).Wexner便秘评分由术前的(19.9±4.3)分降至术后3个月时的(8.4±2.1)分,差异亦有统计学意义(P＜0.01)；便秘评分的下降一直维持到术后24个月.患者对排粪频次的满意率,在术后3、6、12和24个月时,分别为78.1％、91.1％、94.2％和94.6％.结论 金陵术为混合型顽固性便秘的外科治疗提供了一种新型、安全而有效的术式选择.

abstractsObjective To propose a novel surgical procedure for refractory constipation,namely Jinling procedure,and to explore its safety and efficacy through long-term follow-up.Methods A total of 614 patients with refractory constipation were admitted to the Department of General Surgery between February 2000 and June 2011.Five hundred and fifty-four patients received Jinling procedure and were included in this study.The general clinical data,complications after Jinling procedure,gastrointestinal quality of life index (GIQLI),Wexner constipation scale and satisfaction rate during follow-up were collected.Results No operation-associated death occurred.Increased bowel movement frequency was observed during the perioperative period.Temporary difficulty in urination occurred in 24.5％ of the patients.Other complications included small bowel obstruction (9.6％),anastomotic bleeding (8.1％),anastomotic leakage (3.1％),sexual dysfunction (3.1％),and wound infection (3.1％).Most postoperative complications were managed conservatively.The most recent follow-up was on August 2011,and the follow-up rate was 100％,88.8％,75.1％,56.3％ at 3,6,12,and 24 months after surgery.GIQLI temporarily increased from 78.1±9.4 preoperatively to 92.0±9.5 at 3 months follow-up,but continued to decrease during the follow-up at the 6 months (48.4± t 4.1 ),12 months (21.0±4.3),and 24 months (20.0±3.4).Wexner constipation scale decreased from 19.9±4.3 preoperatively to 8.4±2.1 at 3 months follow-up (P＜0.01).The low Wexner scale sustained until 24 months after operation.The satisfaction rate at the 3,6,12 and 24 months follow-up was 78.1％,91.1％,94.2％ and 94.6％,respectively.Conclusion Jinling procedure provides refractory constipation patients with a novel,safe and effective surgical option.