腰椎融合术后肠功能障碍的治疗进展
Advances in the Treatment of Intestinal Dysfunction after Lumbar Fusion Surgery
DOI: 10.12677/acm.2024.1482237, PDF,   
作者: 张云普*, 付 裕#:内蒙古医科大学第二附属医院脊柱外科,内蒙古 呼和浩特
关键词: 腰椎融合术肠功能障碍肠梗阻Lumbar Fusion Bowel Dysfunction Intestinal Obstruction
摘要: 腰椎椎体间融合术是常用的一种治疗腰椎间盘突出、腰椎椎管狭窄等疾病的手术。该术式在临床上应用广泛,但术后大多数患者都会出现不同程度的肠道功能障碍,尤其在腰椎后路融合术更常见,如:术后腹胀、便秘等症状,目前关于该并发症尚未有一种最佳的治疗方式。故本文对腰椎融合术后肠道功能障碍的治疗进展进行综述,并进一步研究以优化治疗,避免高死亡率并发症的发生。
Abstract: Lumbar interbody fusion is a commonly used procedure to treat lumbar disc herniation, lumbar spinal stenosis and other diseases. This procedure is widely used in clinic, but most patients will have different degrees of intestinal dysfunction after surgery, especially more common in lumbar posterior fusion, such as: postoperative abdominal distension, constipation and other symptoms, and there is not yet an optimal treatment regarding this complication. Therefore, this paper reviews the progress of treatment of intestinal dysfunction after lumbar spine fusion, and further studies are conducted to optimize the treatment and avoid the occurrence of high mortality complications.
文章引用:张云普, 付裕. 腰椎融合术后肠功能障碍的治疗进展[J]. 临床医学进展, 2024, 14(8): 461-469. https://doi.org/10.12677/acm.2024.1482237

参考文献

[1] Talia, A.J., Wong, M.L., Lau, H.C. and Kaye, A.H. (2015) Safety of Instrumentation and Fusion at the Time of Surgical Debridement for Spinal Infection. Journal of Clinical Neuroscience, 22, 1111-1116. [Google Scholar] [CrossRef] [PubMed]
[2] Lee, T.H., Lee, J.S., Hong, S.J., Jang, J.Y., Jeon, S.R., Byun, D.W., et al. (2015) Risk Factors for Postoperative Ileus Following Orthopedic Surgery: The Role of Chronic Constipation. Journal of Neurogastroenterology and Motility, 21, 121-125. [Google Scholar] [CrossRef] [PubMed]
[3] Mandl, L.A., Sasaki, M., Yang, J., Choi, S., Cummings, K. and Goodman, S.M. (2019) Incidence and Risk of Severe Ileus after Orthopedic Surgery: A Case-Control Study. HSS Journal®, 16, 272-279. [Google Scholar] [CrossRef] [PubMed]
[4] El-Salhy, M., Hatlebakk, J.G., Gilja, O.H., Bråthen Kristoffersen, A. and Hausken, T. (2019) Efficacy of Faecal Microbiota Transplantation for Patients with Irritable Bowel Syndrome in a Randomised, Double-Blind, Placebo-Controlled Study. Gut, 69, 859-867. [Google Scholar] [CrossRef] [PubMed]
[5] Maloney, N. and Vargas, H.D. (2005) Acute Intestinal Pseudo-Obstruction (Ogilvie’s Syndrome). Clinics in Colon and Rectal Surgery, 18, 96-101. [Google Scholar] [CrossRef] [PubMed]
[6] Bharucha, A.E., Camilleri, M., Low, P.A. and Zinsmeister, A.R. (1993) Autonomic Dysfunction in Gastrointestinal Motility Disorders. Gut, 34, 397-401. [Google Scholar] [CrossRef] [PubMed]
[7] Ehrhardt, J.D., Weber, C., Carey, F.J., et al. (2024) Anatomy, Thorax, Greater Splanchnic Nerves. StatPearls Publishing, Treasure Island.
[8] Iovino, P., Chiarioni, G., Bilancio, G., Cirillo, M., Mekjavic, I.B., Pisot, R., et al. (2013) New Onset of Constipation during Long-Term Physical Inactivity: A Proof-of-Concept Study on the Immobility-Induced Bowel Changes. PLOS ONE, 8, e72608. [Google Scholar] [CrossRef] [PubMed]
[9] De Schryver, A.M., Keulemans, Y.C., Peters, H.P., Akkermans, L.M., Smout, A.J., De Vries, W.R., et al. (2005) Effects of Regular Physical Activity on Defecation Pattern in Middle-Aged Patients Complaining of Chronic Constipation. Scandinavian Journal of Gastroenterology, 40, 422-429. [Google Scholar] [CrossRef] [PubMed]
[10] Muller-Lissner, S.A., Kamm, M.A., Scarpignato, C. and Wald, A. (2005) Myths and Misconceptions about Chronic Constipation. The American Journal of Gastroenterology, 100, 232-242. [Google Scholar] [CrossRef] [PubMed]
[11] Mugie, S.M., Benninga, M.A. and Di Lorenzo, C. (2011) Epidemiology of Constipation in Children and Adults: A Systematic Review. Best Practice & Research Clinical Gastroenterology, 25, 3-18. [Google Scholar] [CrossRef] [PubMed]
[12] Chien, L., Liou, Y.M. and Chang, P. (2011) Low Defaecation Frequency in Taiwan Region Adolescents: Association with Dietary Intake, Physical Activity and Sedentary Behaviour. Journal of Paediatrics and Child Health, 47, 381-386. [Google Scholar] [CrossRef] [PubMed]
[13] Khansari, M., Sohrabi, M. and Zamani, F. (2013) The Useage of Opioids and Their Adverse Effects in Gastrointestinal Practice: A Review. Middle East Journal of Digestive Diseases, 5, 5-16.
[14] Leppert, W. (2012) The Impact of Opioid Analgesics on the Gastrointestinal Tract Function and the Current Management Possibilities [Polish Version: Wpływ opioidowych środków przeciwbólowych na czynność układu pokarmowego oraz aktualne możliwości postępowania terapeutycznego p. 132]. Współczesna Onkologia, 2, 125-139. [Google Scholar] [CrossRef] [PubMed]
[15] Pappagallo, M. (2001) Incidence, Prevalence, and Management of Opioid Bowel Dysfunction. The American Journal of Surgery, 182, S11-S18. [Google Scholar] [CrossRef] [PubMed]
[16] Ay, A.A., Kutun, S., Ulucanlar, H., Tarcan, O., Demir, A. and Cetin, A. (2011) Risk Factors for Postoperative Ileus. Journal of the Korean Surgical Society, 81, 242-249. [Google Scholar] [CrossRef] [PubMed]
[17] Yilmaz, E., Benca, E., Patel, A.P., Hopkins, S., Blecher, R., Abdul-Jabbar, A., et al. (2021) What Are Risk Factors for an Ileus after Posterior Spine Surgery?—A Case Control Study. Global Spine Journal, 12, 1407-1411. [Google Scholar] [CrossRef] [PubMed]
[18] Fineberg, S.J., Nandyala, S.V., Kurd, M.F., Marquez-Lara, A., Noureldin, M., Sankaranarayanan, S., et al. (2014) Incidence and Risk Factors for Postoperative Ileus Following Anterior, Posterior, and Circumferential Lumbar Fusion. The Spine Journal, 14, 1680-1685. [Google Scholar] [CrossRef] [PubMed]
[19] Qureshi, R., Puvanesarajah, V., Jain, A., Shimer, A.L., Shen, F.H. and Hassanzadeh, H. (2017) A Comparison of Anterior and Posterior Lumbar Interbody Fusions: Complications, Readmissions, Discharge Dispositions, and Costs. Spine, 42, 1865-1870. [Google Scholar] [CrossRef] [PubMed]
[20] Scaduto, A.A., Gamradt, S.C., Yu, W.D., Huang, J., Delamarter, R.B. and Wang, J.C. (2003) Perioperative Complications of Threaded Cylindrical Lumbar Interbody Fusion Devices: Anterior versus Posterior Approach. Journal of Spinal Disorders & Techniques, 16, 502-507. [Google Scholar] [CrossRef] [PubMed]
[21] Türler, A., Schnurr, C., Nakao, A., Tögel, S., Moore, B.A., Murase, N., et al. (2007) Endogenous Endotoxin Participates in Causing a Panenteric Inflammatory Ileus after Colonic Surgery. Annals of Surgery, 245, 734-744. [Google Scholar] [CrossRef] [PubMed]
[22] Mukai, R., Handa, O., Naito, Y., Takayama, S., Suyama, Y., Ushiroda, C., et al. (2019) High-fat Diet Causes Constipation in Mice via Decreasing Colonic Mucus. Digestive Diseases and Sciences, 65, 2246-2253. [Google Scholar] [CrossRef] [PubMed]
[23] National Collaborating Centre for N, Supportive C. National Institute for Health and Clinical Excellence: Guidance (2008) Irritable Bowel Syndrome in Adults: Diagnosis and Management of Irritable Bowel Syndrome in Primary Care. Royal College of Nursing, London.
[24] Takano, S. and Sands, D.R. (2015) Influence of Body Posture on Defecation: A Prospective Study of “the Thinker” Position. Techniques in Coloproctology, 20, 117-121. [Google Scholar] [CrossRef] [PubMed]
[25] Coggrave, M., Wiesel, P.H. and Norton, C. (2006) Management of Faecal Incontinence and Constipation in Adults with Central Neurological Diseases. Cochrane Database of Systematic Reviews, No. 2, CD002115.
[26] Hwang, M., Zebracki, K. and Vogel, L.C. (2017) Long-Term Outcomes and Longitudinal Changes of Neurogenic Bowel Management in Adults with Pediatric-Onset Spinal Cord Injury. Archives of Physical Medicine and Rehabilitation, 98, 241-248. [Google Scholar] [CrossRef] [PubMed]
[27] Ozisler, Z., Koklu, K., Ozel, S. and Unsal-Delialioglu, S. (2015) Outcomes of Bowel Program in Spinal Cord Injury Patients with Neurogenic Bowel Dysfunction. Neural Regeneration Research, 10, 1153-1158. [Google Scholar] [CrossRef] [PubMed]
[28] Pardee, C., Bricker, D., Rundquist, J., MacRae, C. and Tebben, C. (2012) Characteristics of Neurogenic Bowel in Spinal Cord Injury and Perceived Quality of Life. Rehabilitation Nursing, 37, 128-135. [Google Scholar] [CrossRef] [PubMed]
[29] Forootan, M., Bagheri, N. and Darvishi, M. (2018) Chronic Constipation: A Review of Literature. Medicine, 97, e10631. [Google Scholar] [CrossRef] [PubMed]
[30] Gor, R.A., Katorski, J.R. and Elliott, S.P. (2016) Medical and Surgical Management of Neurogenic Bowel. Current Opinion in Urology, 26, 369-375. [Google Scholar] [CrossRef] [PubMed]
[31] DiPalma, J.A., Buckley, S.E., Warner, B.A. and Culpepper, R.M. (1996) Biochemical Effects of Oral Sodium Phosphate. Digestive Diseases and Sciences, 41, 749-753. [Google Scholar] [CrossRef] [PubMed]
[32] Gu, L., Ding, C., Tian, H., Yang, B., Zhang, X., Hua, Y., et al. (2018) Use of Gastrografin in the Management of Faecal Impaction in Patients with Severe Chronic Constipation: A Randomized Clinical Trial. ANZ Journal of Surgery, 89, 239-243. [Google Scholar] [CrossRef] [PubMed]
[33] Yi, Z., Jie, C., Wenyi, Z., Bin, X. and Hongzhu, J. (2014) Comparison of Efficacies of Vegetable Oil Based and Polyethylene Glycol Based Bisacodyl Suppositories in Treating Patients with Neurogenic Bowel Dysfunction after Spinal Cord Injury: A Meta-Analysis. The Turkish Journal of Gastroenterology, 25, 488-492. [Google Scholar] [CrossRef] [PubMed]
[34] Daniels, A.H., Ritterman, S.A. and Rubin, L.E. (2015) Paralytic Ileus in the Orthopaedic Patient. Journal of the American Academy of Orthopaedic Surgeons, 23, 365-372. [Google Scholar] [CrossRef] [PubMed]
[35] 陶涛, 刘小兰, 赵颖颖, 等. 术前口服碳水化合物联合莫沙必利对胸腰椎融合术患者胃容量及术后胃肠功能恢复的影响[J]. 哈尔滨医科大学学报, 2023, 57(6): 653-658.
[36] Camilleri, M., Kerstens, R., Rykx, A. and Vandeplassche, L. (2008) A Placebo-Controlled Trial of Prucalopride for Severe Chronic Constipation. New England Journal of Medicine, 358, 2344-2354. [Google Scholar] [CrossRef] [PubMed]
[37] Emmanuel, A., Cools, M., Vandeplassche, L. and Kerstens, R. (2014) Prucalopride Improves Bowel Function and Colonic Transit Time in Patients with Chronic Constipation: An Integrated Analysis. American Journal of Gastroenterology, 109, 887-894. [Google Scholar] [CrossRef] [PubMed]
[38] Krogh, K., Jensen, M.B., Gandrup, P., Laurberg, S., Nilsson, J., Kerstens, R., et al. (2002) Efficacy and Tolerability of Prucalopride in Patients with Constipation Due to Spinal Cord Injury. Scandinavian Journal of Gastroenterology, 37, 431-436. [Google Scholar] [CrossRef] [PubMed]
[39] Ponec, R.J., Saunders, M.D. and Kimmey, M.B. (1999) Neostigmine for the Treatment of Acute Colonic Pseudo-obstruction. New England Journal of Medicine, 341, 137-141. [Google Scholar] [CrossRef] [PubMed]
[40] Christensen, P., Olsen, N., Krogh, K., Bacher, T. and Laurberg, S. (2003) Scintigraphic Assessment of Retrograde Colonic Washout in Fecal Incontinence and Constipation. Diseases of the Colon & Rectum, 46, 68-76. [Google Scholar] [CrossRef] [PubMed]
[41] Dale, M., Morgan, H., Carter, K., White, J. and Carolan-Rees, G. (2018) Peristeen Transanal Irrigation System to Manage Bowel Dysfunction: A NICE Medical Technology Guidance. Applied Health Economics and Health Policy, 17, 25-34. [Google Scholar] [CrossRef] [PubMed]
[42] Emmanuel, A. (2010) Review of the Efficacy and Safety of Transanal Irrigation for Neurogenic Bowel Dysfunction. Spinal Cord, 48, 664-673. [Google Scholar] [CrossRef] [PubMed]
[43] Fourtassi, M., Charvier, K., Hajjioui, A., Havé, L. and Rode, G. (2012) Intérêt des irrigations transanales dans la gestion des troubles intestinaux et ano-rectaux chez les blessés médullaires. Progrès en Urologie, 22, 467-474. [Google Scholar] [CrossRef] [PubMed]
[44] Mazor, Y., Jones, M., Andrews, A., Kellow, J.E. and Malcolm, A. (2016) Anorectal Biofeedback for Neurogenic Bowel Dysfunction in Incomplete Spinal Cord Injury. Spinal Cord, 54, 1132-1138. [Google Scholar] [CrossRef] [PubMed]
[45] Aloysius, M.M., Korsten, M.A., Radulovic, M., Singh, K., Lyons, B.L., Cummings, T., et al. (2023) Lack of Improvement in Anorectal Manometry Parameters after Implementation of a Pelvic Floor/Anal Sphincter Biofeedback in Persons with Motor‐Incomplete Spinal Cord Injury. Neurogastroenterology & Motility, 35, e14667. [Google Scholar] [CrossRef] [PubMed]
[46] Korsten, M.A., Fajardo, N.R., Rosman, A.S., Creasey, G.H., Spungen, A.M. and Bauman, W.A. (2004) Difficulty with Evacuation after Spinal Cord Injury: Colonic Motility during Sleep and Effects of Abdominal Wall Stimulation. The Journal of Rehabilitation Research and Development, 41, 95-100. [Google Scholar] [CrossRef] [PubMed]
[47] Worsøe, J., Rasmussen, M., Christensen, P. and Krogh, K. (2013) Neurostimulation for Neurogenic Bowel Dysfunction. Gastroenterology Research and Practice, 2013, Article ID: 563294. [Google Scholar] [CrossRef] [PubMed]
[48] Rasmussen, M.M., Kutzenberger, J., Krogh, K., Zepke, F., Bodin, C., Domurath, B., et al. (2015) Sacral Anterior Root Stimulation Improves Bowel Function in Subjects with Spinal Cord Injury. Spinal Cord, 53, 297-301. [Google Scholar] [CrossRef] [PubMed]
[49] Patel, A.S., Saratzis, A., Arasaradnam, R. and Harmston, C. (2015) Use of Antegrade Continence Enema for the Treatment of Fecal Incontinence and Functional Constipation in Adults: A Systematic Review. Diseases of the Colon & Rectum, 58, 999-1013. [Google Scholar] [CrossRef] [PubMed]
[50] Poirier, M., Abcarian, H. and Nelson, R. (2007) Malone Antegrade Continent Enema: An Alternative to Resection in Severe Defecation Disorders. Diseases of the Colon & Rectum, 50, 22-28. [Google Scholar] [CrossRef] [PubMed]
[51] Furlan, J.C., Urbach, D.R. and Fehlings, M.G. (2007) Optimal Treatment for Severe Neurogenic Bowel Dysfunction after Chronic Spinal Cord Injury: A Decision Analysis. British Journal of Surgery, 94, 1139-1150. [Google Scholar] [CrossRef] [PubMed]
[52] Smith, P.H. and Decter, R.M. (2014) Antegrade Continence Enema Procedure: Impact on Quality of Life in Patients with Spinal Cord Injury. Spinal Cord, 53, 213-215. [Google Scholar] [CrossRef] [PubMed]
[53] Coggrave, M.J., Ingram, R.M., Gardner, B.P. and Norton, C.S. (2012) The Impact of Stoma for Bowel Management after Spinal Cord Injury. Spinal Cord, 50, 848-852. [Google Scholar] [CrossRef] [PubMed]
[54] 丁超利. 四磨汤加减联合针刺预防老年腰椎退变性疾病术后腹胀的临床研究[D]: [硕士学位论文]. 郑州: 河南中医药大学, 2022.
[55] 张博华, 刘军, 任伟剑, 等. 针刺对腰椎融合术后胃肠功能障碍效果分析[J]. 实用中医内科杂志, 2023: 1-5.
[56] 肖祥. 香槟方结合针足三里对腰椎融合术后胃肠功能的影响[D]: [硕士学位论文]. 广州: 广州中医药大学, 2019.