联合术式治疗出口梗阻型便秘的临床观察  

The therapeutic effects of combination surgical mode on outlet obstruction constipation

作　　者：代拥军[1] 刘浩[1] 杨静 胡金[3] 王园园[1] 徐菲[1] DAI Yongjun;LIU Hao;YANG Jing(Department of General Surgery,The First Hospital of Hebei Medical University,Hebei,Shijiazhuang 050031,China)

机构地区：[1]河北医科大学第一医院普外科,石家庄市050031 [2]河北省任丘市人民医院外科 [3]河北省定州市人民医院胃肠外科

出　　处：《河北医药》2018年第23期3578-3581,3585,共5页Hebei Medical Journal

基　　金：河北省医学科学研究重点课题(编号:20160675);河北省科学技术研究与发展指导计划项目(编号:152777177)

摘　　要：目的对出口梗阻型便秘患者行耻骨直肠肌部分离断术、直肠阴道隔薄弱补片修补术、经吻合器直肠黏膜环切术(PPH)联合(三术式)治疗及单纯PPH治疗,评定其对出口梗阻型便秘的术后疗效。方法对2011年12月至2016年10月收治170例患者,行三术式联合治疗85例,单纯行PPH术85例,2组患者手术、住院时间及术后1、3、6个月便秘缓解情况评分加以对比分析总结。结果随访1～6个月,有效率优于对照组(P <0. 05),手术时间较对照组长,差异有统计学意义(P <0. 05),住院时间差异无统计学意义(P> 0. 05),术后1、3、6个月排便情况评分差异有统计学意义(P <0. 05)。术后6个月排粪造影力排像在直肠前突程度、肛直角角度、肛直角增大度数比较差异有统计学意义(P <0. 05),会阴下降程度、静息位肛直角比较差异无统计学意义(P> 0. 05)。结论三术式联合治疗出口梗阻型便秘是低创伤、成功利率高、近远期疗效稳定的治疗手段。Objective The observe and compare the therapeutic effects of partial separation of the puborectalis muscle,repair of the rectovaginal weakness patch,procedure for prolapse and hemorrhoids(PPH)and combination surgical treatment of the three kinds of surgical methods on outlet obstruction constipation.Methods A total of 170 patients with outlet obstruction constipation who were admitted and treated in our hospital from December 2011 to October 2016 were randomly divided into PPH treatment group(n=85)and combination treatment group(n=85).The patients in PPH treatment group were treated by simple PPH operation,however,the patients in combination treatment group were treated by combination treatment of the three kinds of surgical methods.The operation time,hospitalization time and the scores of constipation relief at 1m,3m,6m after surgery were observed and compared between the two grousp.Results After 6-month follow-up,the total effective rate combination treatment group was superior to that in PPH treatment group(P<0.05),and the operation time in combination treatment group was significantly longer than that in PPH treatment group(P<0.05),however,there was no significant difference in the length of hospital stay between the two groups(P>0.05).There were significant differences in the the scores of constipation relief at 1m,3m,6m after surgery between two groups,moreover,there were significant differences in the the degree of rectal protuberance,the angle of anal right angle,and the degree of enlargement of rectal right angle at 6m after operation between two groups(P<0.05),but there was no significant difference in the degree of perineal decline and the anal right angle at resting position between two grousp(P>0.05).Conclusion The combination treatment of three surgical methods in treatment of outlet obstruction constipation is a therapeutic tool with low trauma,high success rate and stable short-term curative effects.

关 键 词：便秘 出口梗阻性 直肠前突 耻骨直肠肌离断术 

分 类 号：R442.2[医药卫生—诊断学]