直肠前壁全层切闭术治疗出口梗阻型便秘的效果评价  

Assess of the effect on rectal anterior wall full-thickness incision for outlet obstruction constipation due to rectocele

作　　者：陈丙学 廖颖婴[2] CHEN Bingxue;LIAO Yingying(Department of Anorectal Surgery,The Changzhou Second People′s Hospital Affiliated of Nanjing Medical University,Jiangsu Changzhou 213300,China;Department of Anorectal Surgery,Shenzhen Hospital of Traditional Chinese Medicine,Guangdong Shenzhen 518000 ,China)

机构地区：[1]南京医科大学附属常州第二人民医院肛肠科,江苏常州213000 [2]深圳市中医院肛肠科,广东深圳518034

出　　处：《新疆医科大学学报》2019年第3期325-327,共3页Journal of Xinjiang Medical University

基　　金：深圳市科技研发基金(JCYJ20160428175517213)

摘　　要：目的评价直肠前壁全层切闭术治疗中重度直肠前突所致出口梗阻型便秘的临床疗效。方法选择2009年1月-2015年1月在深圳市中医医院肛肠科行直肠前壁全层切闭术治疗的40例患者为研究对象,患者术后3、6、12、24个月接受随访,以术后平均手术时间、平均住院时间、术中出血量、术后并发症、便秘症状严重程度(SS)评分、生活质量量表评分(PAC-QoL)作为评价指标,对治疗效果进行评价。结果患者平均手术时间26 min(18～40 min),术后平均住院时间4 d(3～5 d),术中平均出血量30 mL(20～45 mL)。患者术后发生大出血1例,肛门坠胀2例,尿潴留2例,肛门轻度失禁3例。与术前患者SS评分[(16.40±3.56)分]比较,患者术后3个月SS评分[(5.30±2.08)分]、术后6个月SS评分[(4.86±1.67)分]、术后12个月SS评分[(4.75±1.56)分]、术后24个月SS评分[(4.65±1.42)分]均降低,差异有统计学意义(P<0.05)。与患者术前PAC-QoL评分[(51.14±9.20)分]比较,患者术后3个月PAC-QoL评分[(16.19±1.87)分]、术后6个月PAC-QoL评分[(16.41±1.64)分]、术后12个月PAC-QoL评分[(16.76±1.46)分]、术后24个月PAC-QoL评分[(15.20±1.44)分]均降低,差异有统计学意义(P<0.05),临床总有效率为90%。结论直肠前壁全层切闭术对直肠前突所致出口梗阻型便秘有较好的治疗效果,术后并发症少,手术方法操作简单,值得临床推广。ObjectiveTo evaluate the clinical effectiveness of anterior resection of the anterior wall full-thickness of the rectum in the treatment of outlet obstructive constipation(ODS)caused by moderate and severe rectocele.MethodsA total of 40 patients with ODS caused by moderate and severe rectocele underwent TST in The Shenzhen Municipal TCM Hospital from January 2009 to January 2015 were enrolled.The patients were followed up at the 3rd,6th,12th,and 24th months after operation.Primary outcomes,including operation time,intraoperative blood loss,hospital stay,the score of postoperative complication,symptom severity(SS)score and patient assessment of constipation quality of life(PAC-QOL)questionnaire were collected as an evaluation index to evaluate the therapeutic effect.ResultsMean operative time was 26 minutes(range,18-40 minutes),mean hospitalization was 4.0 days(range,3-5 days),and intraoperative blood loss was 30ml(range,20-45 mL).A total of 8 complications were reported,including major bleeding(n=1),minor fecal incontinence(n=3),uroschesis(n=2),anal tenesmus(n=2).Compared with the preoperative SS score(16.40±3.56),the postoperative SS score(5.30±2.08),the postoperative SS score(4.86±1.67),the postoperative SS score(4.75±1.56)and the postoperative SS score(4.65±1.42)were all decreased at 3rd,6th,12th and 24th month,respectively,with statistically significant differences(P<0.05).Compared with patients′preoperative PAC-QOL score(51.14±9.20),patients′postoperative PAC-QOL score(16.19±1.87),postoperative PAC-QOL score(16.41±1.64),postoperative PAC-QOL score(16.76±1.46),and postoperative PAC-QOL score(15.20±1.44)all decreased at 3rd,6th,12th and 24th month after surgery,with statistically significant difference(P<0.05).The total clinical effective rate was 90%.ConclusionAnterior resection of the anterior wall full-thickness of the rectum has a better therapeutic effect on outlet obstructive constipation caused by rectocele,with fewer complications and simple operation,which is worthy of clinical promotion

关 键 词：直肠前壁全层切闭术 直肠前突 痔上粘膜切除吻合术 出口梗阻型便秘 

分 类 号：R574.6[医药卫生—消化系统]