PPH治疗直肠黏膜内脱垂型便秘的临床研究  

PPH for Constipation of Internal Rectal Mucosa Prolapse.Clinical Research

作　　者：尚晓春 刘永强 SHANG Xiao-chun;LIU Yong-qiang(General Surgery Dept. of the People＇s Hospital of Chongqing City ,Chongqing 400013)

机构地区：[1]重庆市人民医院普通外科,重庆400013

出　　处：《中国肛肠病杂志》2017年第9期42-45,共4页Chinese Journal of Coloproctology

摘　　要：为探讨PPH治疗轻度直肠黏膜内脱垂（IRMP）型便秘的临床疗效及价值，将2014年10月至2015年10月重庆市人民医院收治的67例IRMP型便秘患者，随机分为治疗组和对照组。治疗组33例，采用吻合器痔上黏膜环切术（PPH）治疗，对照组34例，采用传统开放式手术治疗。观察比较2组患者临床指标、治疗效果、术后为期3个月的随访评分3个方面的差异，比较术前和术后的排粪造影情况及治疗前后的积分差值，并进行量化评分比较。结果显示。2组患者术后肛周疼痛程度（x^2=9．86，P=0．02）、肛门部坠胀感（x^2=5．48，P=0．02）比较差异有统计学意义；2组患者术后排粪造影检查结果，直肠前突（Rc）和IRMP程度，差异亦有统计学意义（t=5．45，P=0．00；t=6．61，P=0．00）；治疗组总有效率为100．0％（33／33）高于对照组的97．1％（33／34）；2组患者术后3个月的随访疗效指数比较，治疗组疗效指数为（64．31±2．11）％，对照组为（32．86±2．66）％，差异亦有统计学意义（t=53，70，P=0．00）。结果表明，临床运用PPH治疗轻度IRMP型便秘，具有微创、安全、患者术后恢复快、复发率低等优点，临床疗效更好，能显著减轻患者术后疼痛感，值得临床推广应用。This study was to explore the clinical effect of PPH in the treatment of mild constipation of in- ternal rectal mucosa prolapse（IRMP）,and evaluate its value,randomly divided 67 cases with IRMP admit- ted and treated in authors＂ hospital from Oct. 2014 to Oct. 2015 into treatment group and control one, which the former （ n =33） received PPH, the latter（ n = 34） received traditional open surgery; then ob- served and compared both groups＂ the difference in the ratings on clinical indicators, curative effect, and the follow-up of postoperative 3 months,as well as the difference of the rating on the defecography condition between preoperation and postoperation, and the difference of the rating between pretreatment and pos- treatment and compared the quantitative score. As results, in perianal pain degree, and in anal tenesmus there was statistical difference （all P =0.02） between both groups;in the degree of rectocele and the de- gree of IRMP showed by defecography there was statistical difference（ t =5.45, P =0.00; t =6.61, P = 0.00） the total effective rate of the former was higher than that of the latter（33/33,100% vs 33/34, 97.1 %） ;the effect indexes obtained by the follow-up of postoperative 3 months the former was higher than the latter,there was statistical difference[（64.31±2.11）% vs （32.86±2.66）%, t =53.70, P =0.00].Re- sults show that the procedure used in the former （with mild constipation of IRMP） has such merits as min- imally invasive, safe, faster postoperative recovery, and low recurrence rate, etc, as well as better effect, can significantly relieve patient＇s pain.Thus it is worthy of popularization and clinical use.

关 键 词：直肠黏膜内脱垂 便秘 吻合器痔上黏膜环切术 

分 类 号：R657.18[医药卫生—外科学]