吻合器经肛门直肠切除术治疗痔上黏膜环切钉合术术后直肠套叠的疗效初探  

Therapeutic effect of the stapled transanal rectal resection procedure for rectal intussusception after procedure for prolapse and hemorrhoids

作　　者：陶琦[1] 江从庆[2] 刘永安[1] 张东平[1] 

机构地区：[1]湖北省荆州市第一人民医院外科,434000 [2]武汉大学中南医院肛肠外科

出　　处：《临床外科杂志》2016年第3期207-209,共3页Journal of Clinical Surgery

摘　　要：目的探讨吻合器经肛直肠切除术治疗痔上黏膜环切钉合术后直肠套叠的可行性、安全性及疗效。方法 11例痔上黏膜环切钉合术后诊断为出口梗阻型便秘的患者,经排粪造影发现为直肠套叠,9例再次行吻合器经肛直肠切除,通过Longo出口梗阻型便秘评分、Cleveland临床便秘评分及胃肠道生存质量指数(gastrointestinal quality of life index,GIQLI)评估吻合器经肛直肠切除术疗效。结果 9例患者行吻合器经肛直肠切除术,1例男性患者吻合口狭窄,瘢痕松解后仍不能置入吻合器,1例女性患者为瘢痕体质,2例均放弃吻合器直肠切除术。9例患者术后Longo、Cleveland及GILI评分均优于术前(t分别为7.074,9.197,7.439),差异有统计学意义(P<0.05)。平均随访6个月,1例效果不佳,无重大手术并发症。结论吻合器经肛直肠切除术治疗痔上黏膜环切钉合术后直肠套叠是安全、可行和有效的。Objective To study the feasibility, safetyandtherapeutic effect of stapled transanal rectal resection（STARR） procedure for rectal intussusception after procedure for prolapse and hemor- rhoids （PPH）. Methods Eleven patients with PPH were diagnosed as outlet obstruction constipation （ODS） and defecography showed rectal intussusception as the cause. Nine patients of them received STARR procedure and the outcomes were evaluated by Longo ODS score, Cleveland clinic constipation score（CCCS） and gastrointestinal quality of life index （GIQLI）. Results Nine patients underwent STARR and two patients gave up their treatment. One of the two patients was a male with anastomotic ste- nosis and the stapler cannot be implanted even after remission of the stenosis. The treatment for the other female patient withscar diathesis also failed. For the nine patients with STARR, the Longo ODS score （ t = 7. 074） ,CCCS （t = 9. 197） and GIQLI （t = 7. 439） were all superior to the preoperative data （P 〈 0.05 ）. The average follow-up period was 6 months. One patient had unsatisfied result but there was no major surgical complication. Conclusion For rectal intussusception after PPH, STARR issafe, feasible and effective.

关 键 词：直肠套叠 直肠切除 患者满意度 

分 类 号：R657.18[医药卫生—外科学]