Objective: To evaluate the safety, effectiveness, and long-term efficacy of the Jinling procedure for management of refractory mixed constipation. Methods: We prospectively collected clinical data of patients with refractory mixed constipation treated by the Jinling procedure in the Institute of General Surgery of our hospital from January 2007 to August 2023. Perioperative complications, effectiveness within 1 year of surgery (as assessed by the Wexner constipation score, gastrointestinal quality of life index, frequency of spontaneous defecation, rate of satisfactory defecation, body composition, serological indicators, defecography, anorectal manometry) and 10 years after surgery (as assessed by the Wexner constipation score, patient assessment of constipation symptom, SF-36 quality of life score, and questionnaire concerning satisfaction with defecation). Results: The study cohort comprised 3310 patients of mean age 44±15 years, including 653 men and 2657 women. The duration of constipation was 141±114 months. The 1-month, 3-month, 6-month, and 12-month follow-up rates were 98.07% (3246/3310), 95.11% (3148/3310), 93.38% (3091/3310), and 92.81% (3072/3310), respectively. Overall, 1100 patients had undergone surgery at least 10 years previously, 683 of whom completed the questionnaire, making the 10-year follow-up rate 62.09%. The overall incidence of postoperative complications was 21.99% (728/3310), mortality 0.45% (15/3310), and duration of postoperative hospital stay 12.5±5.4 days. Compared with preoperative values, Wexner scores decreased significantly from 1 to 12 months after surgery, whereas the gastrointestinal quality of life index scores had gradually increased by 3 months after surgery; both changes were statistically significant (both P < 0.001). The frequency of spontaneous defecation increased significantly to > five times/day 1 month after surgery, following which it decreased gradually with time, falling to two to five times/day by 6 months after surgery. All nutritional indicators returned to preoperative levels within 1 year except for that of inorganic salt, which did not change significantly. By 6-12 months after surgery, the proportions of rectocele, mucosal prolapse, internal rectal intussusception, visceral ptosis, perineal descent, pelvic floor spasm, and puborectalis syndrome assessed by defecography were all significantly lower than before surgery (all P < 0.05). By 3 months after surgery, the anal resting pressure, anal maximum systolic pressure, and anorectal depression had all returned to preoperative levels. Twelve months after surgery, the rectoanal inhibition reflex was stronger than that before surgery, whereas anal relaxation was less pronounced than that before surgery; these differences are statistically significant (both P < 0.05). The Wexner scores (7±2 vs. 21±6) and patient assessment of constipation symptoms scores (13±5 vs. 39±5) were significantly lower 10 years after the Jinling procedure than they had been before surgery. The eight dimensions of the SF-36 quality of life scores for physical functioning (90±5 vs. 78±8), role limitations in physical functioning (89±12 vs. 50±24), bodily pain (67±18 vs. 33±22), emotional well-being (63±23 vs. 48±30), vitality (71±11 vs. 31±13), mental health (71±10 vs. 30±10), social functioning (69±17 vs. 26±15) and general health (79±9 vs. 35±12) had all improved significantly (all P < 0.001). The total rates of satisfaction with defecation were 95.02% (2919/3072) and 87.56% (598/683) 1 year and 10 years after surgery, respectively. Conclusion: The Jinling procedure is a safe and effective means of treating refractory mixed constipation, achieving improvement in long-term defecation function and gastrointestinal quality of life.
目的： 评价金陵术治疗顽固性混合型便秘的安全性、有效性和长期疗效。 方法： 前瞻性收集2007年1月至2023年8月在东部战区总医院普通外科研究所接受金陵术治疗顽固性混合型便秘患者的临床资料，观察围手术期并发症、术后1年内的疗效随访［包括Wexner便秘评分、胃肠生活质量评分（GIQLI）、自主排便频率、排便满意率、机体组成和血清学指标、排粪造影、肛门直肠测压］和术后10年随访［包括Wexner便秘评分、便秘患者症状自评（PAC-SYM）评分、健康调查简表（SF-36）评分、排便满意率的问卷调查］。 结果： 共3 310例患者纳入研究，年龄（44±15）岁，其中男653例，女2 657例；便秘病程为（141±114）个月；术后1个月、3个月、6个月以及12个月随访率分别为98.07%（3 246/3 310）、95.11%（3 148/3 310）、93.38%（3 091/3 310）、92.81%（3 072/3 310）。全组中，术后满10年的患者1 100例，其中683例完成问卷调查，随访率为62.09%。全组术后总并发症发生率为21.99%（728/3 310），病死率为0.45%（15/3 310），术后住院时间为（12.5±5.4）d。与术前相比，患者术后1~12个月的Wexner评分均明显下降，术后3个月后GIQLI评分逐渐升高，差异均有统计学意义（均P<0.001）；术后1个月自主排便频率明显增多（>5次/d），后随时间推移逐渐减少，术后6个月减少至2~5次/d；营养指标除无机盐量水平变化不明显外，其他指标均在1年内恢复至术前水平。术后6~12个月时，排粪造影显示的直肠前突、黏膜脱垂、直肠内套叠、内脏下垂和会阴下降、盆底痉挛和耻骨直肠肌综合征比例均明显低于术前，差异均有统计学意义（均P<0.05）。术后3个月时，患者肛管静息压、肛管最大收缩压、直肠肛管抑制均恢复至术前水平；且术后12个月时，直肠肛管抑制反射高于术前水平，肛管松弛压低于术前水平，差异均有统计学意义（均P<0.05）。与术前相比，金陵术后10年患者Wexner评分［（7±2）分比（21±6）分］和PAC-SYM评分［（13±5）分比（39±5）分］均明显降低，SF-36生活质量评分的8个维度分别为生理机能［（90±5）分比（78±8）分］、生理职能［（89±12）分比（50±24）分］、躯体疼痛［（67±18）分比（33±22）分］、情感职能［（63±23）分比（48±30）分］、精力［（71±11）分比（31±13）分］、精神健康［（71±10）分比（30±10）分］、社会功能［（69±17）分比（26±15）分］以及总体健康［（79±9）分比（35±12）分］，均明显提高；差异均有统计学意义（均P<0.001）。术后1年和10年随访患者排便总满意率分别为95.02%（2 919/3 072）和87.56%（598/683）。 结论： 金陵术治疗顽固性混合型便秘具有较为理想的安全性和有效性，能够改善患者术后长期的排便功能和胃肠生活质量。.