改良吻合器痔上黏膜环切术联合直肠黏膜塔状缝合术在直肠前突中的应用  

Application of modified procedure for prolapse and hemorrhoids combined with pagoda suture by anorectal mucosa in patients with rectocele

作　　者：赵卫红[1] 冯运章[1] 吕保芳[2] 李华[3] 王伟栋 郭明海 吴晓伟[3] Zhao Weihong;Feng Yunzhang;Lyu Baofang;Li Hua;Wang Weidong;Guo Minghai;Wu Xiaowei(The Second Department of General Surgery;Department of Preventive Care, Handan Third Hospital,Handan 056001, China;Department of Radiology, Handan Central Hospital, Handan 056001, China)

机构地区：[1]邯郸市中心医院普外二科,056001 [2]邯郸市第三医院防保科,056001 [3]邯郸市中心医院放射科,056001

出　　处：《中华普通外科学文献（电子版）》2018年第3期180-183,共4页Chinese Archives of General Surgery(Electronic Edition)

基　　金：邯郸市科学技术研究与发展计划项目(1528108167)

摘　　要：目的探究改良吻合器痔上黏膜环切术(PPH)联合直肠黏膜塔状缝合术治疗直肠前突的应用疗效。方法选择2013年5月至2017年8月在邯郸市中心医院和邯郸市第三医院确诊并接受治疗的直肠前突女性患者60例,将其随机分成两组,各30例。试验组进行改良PPH术联合直肠黏膜塔状缝合术治疗,对照组仅采用经肛门直肠黏膜塔状缝合术治疗。观察患者便秘改善状况,比较两种手术方法的治疗效果差异和Longo ODS评分。结果两组患者术后便秘状况都有一定改善,术后1个月内疗效以及Longo ODS评分差异无统计学意义;术后3个月试验组的疗效显著优于对照组(Uc=10.469,P<0.05),Longo ODS评分显著低于对照组,差异有统计学意义(5.23±1.56 vs7.35±2.23,t=4.267,P<0.05)。随访期间试验组患者无一例复发,对照组复发5例(16.7%),两组复发率差异无统计学意义(χ~2=3.491,P=0.062)。试验组的并发症发生率为13.3%(4/30),显著低于对照组的53.3%(16/30),差异有统计学意义(χ~2=10.800,P=0.001)。结论改良PPH术联合直肠黏膜塔状缝合术治疗直肠前突更具有优势,在临床上可用于治疗出口梗塞性便秘。Objective To explore the curative effect of modified procedure for prolapse and hemorrhoids（PPH） combined with pagoda suture by anorectal mucosa in the treatment of rectocele. Methods From May 2013 to August 2017, sixty female patients with rectocele diagnosed and treated in Handan Central Hospital and Handan Third Hospital were randomly divided into two groups, with 30 cases in each group. The trial group was treated with modified PPH combined with pagoda suture of rectal mucosa, and the control group was only treated with pagoda suture through anorectal mucosa. The improvement of constipation in patients was observed and the difference of treatment effect and Longo ODS score were compared between the two groups. Results The postoperative constipation condition of both groups had certain improvement, and the curative effect within 1 month after operation and Longo ODS score had no statistical significance. The curative effect of the trial group 3 months after operation was significantly better than that of the control group（Uc=10.469, P〈0.05）, Longo ODS score was significantly lower than the control group, the difference was statistically significant（5.23±1.56 vs 7.35±2.23, t=4.267, P〈0.05）. There was no recurrence in the trial group, and 5 cases（16.7%） in the control group during the follow-up,with no significant difference in recurrence between the two groups（χ^2=3.491,P=0.062）. The complication rate of the trial group was 13.3%（4/30）, which was significantly lower than that of the control group（53.3%, 16/30）, with statistically significant difference（χ^2=10.800, P=0.001）. Conclusion Modified PPH combined with pagoda suture by anorectal mucosa has more advantages and can be used to treat outlet obstructive constipation.

关 键 词：直肠前突 便秘 吻合器痔上黏膜环切术 直肠黏膜塔状缝合 

分 类 号：R657.1[医药卫生—外科学]