摘要手术作为治疗慢性便秘的方法之一,是非手术治疗失败后的最后选择.手术方式选择主要取决于患者的病情、客观检查证据和医生团队的经验:(1)慢传输型便秘:国内目前广泛采用次全结直肠切除加回肠直肠吻合、或升结肠直肠吻合,疗效确切;(2)出口梗阻型便秘:手术治疗需要慎之又慎,目前手术方式并无共识,建议遵循"能微创,则微创"的原则;(3)混合型便秘:尚未有明确统一的外科治疗方法,金陵术是其有前景的手术方式;(4)成人先天性巨结肠:外科手术是唯一治疗方法,基本原则是切除狭窄段、移行段和明显扩张段,推荐同时行预防性回肠造口;(5)成人特发性巨结肠:宜选择次全结肠切除加回肠直肠吻合、或升结肠直肠吻合;(6)神经节细胞减少症:少见,外科治疗未形成共识.如何选择恰当的手术时机和手术方式以及对手术风险的把控,是临床医师必须掌握的内容.随着腔镜技术优势的体现,微创外科将成为便秘手术治疗的主要方向.

abstractsSurgery, as one of the methods for the treatment of chronic constipation, is the final choice after the failure of non-surgical treatment with its specific particularity. The history of surgical treatment of chronic constipation is complex and tortuous. How to select operation among many kinds of surgery, and control risk is difficult for clinician. The choice of surgical procedure depends mainly on the patient′s conditions, the objective examination basis and the experience of physician teams. Based on the previous reports and the team′s experience, this paper discusses the choice of surgical treatment for the following types of chronic constipation: (1) Slow transit constipation: subtotal colorectal resection plus ileorectal anastomosis or ascending colon rectum anastomosis is widely used at present in the domestic, and its efficacy is quite good. (2) Outlet obstructive constipation: surgical treatment needs to be cautious with no consensus , and surgeons must follow the advice of "minimally invasive first"principle. (3) Mixed constipation: there is no clear and unified surgical treatment, while Jinling surgery is a promising way of operation. (4) Adult Hirschsprung′s disease: surgery is the only treatment, and removing the stenosis segment, transitional segment and obvious expansion segment is the basic principle, and preventive ileostomy at the same time is also recommended. (5) Adult idiopathic megacolon:subtotal colectomy with ileorectal anastomosis or ascending colon rectum anastomosis is highly recommended. (6) Hypoganglionosis: it is rare, and no consensus has been reached in surgical treatment. How to select the proper timing and mode of operation, and how to control the operation risk are the contents that clinicians must master. With the development of laparoscopic surgical technology , minimally invasive surgery is becoming the main direction of constipation treatment.