经会阴直肠乙状结肠部分切除术治疗直肠脱垂的临床效果观察  

Clinical observation of perineal rectosigmoidectomy for rectal prolapse

作　　者：宋正明[1] 杨庆华[1] 刘海源[1] 朱渊东 卢城东 Song Zhengming;Yang Qinghua;Liu Haiyuan;Zhu Yuandong;Lu Chengdong

机构地区：[1]义乌市中心医院肛肠外科,浙江省322000

出　　处：《中国基层医药》2019年第19期2362-2365,共4页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的探讨经会阴直肠乙状结肠部分切除术(Altemeier)治疗直肠脱垂的临床价值。方法选取2013年4月至2015年6月义乌市中心医院收治符合直肠脱垂诊断标准患者60例为研究对象,采用随机数字表法分为两组,研究组和对照组各30例。研究组采用Altemeier术,对照组采用三联术(直肠黏膜排列结扎术、直肠周围注射术和肛门环缩术)。比较手术后总有效率。结果两组患者手术均顺利完成,对照组总有效率为80.00%,研究组总有效率为96.67%,两组差异有统计学意义(χ2=5.856,P=0.048)。Wexner便秘评分:研究组(1.4±1.6)分,比对照组的(3.2±2.0)分显著下降(t=3.849,P<0.05)。Wexner肛门失禁评分:研究组24个月后(2.9±1.8)分,比对照组的(4.4±2.7)分显著下降(t=2.532,P<0.05)。研究组吻合口开裂出血、盆腔肿胀和肛周湿疹的比例分别是0.00%、0.00%和3.33%,明显低于对照组的20.00%、23.33%和30.00%(χ2=4.630、5.822、7.680,均P<0.05)。结论Altemeier术可明显改善患者生活质量,治愈率高。Objective To evaluate the clinical observation of rectal prolapse by partial perineal rectal sigmoidectomy. Methods Sixty patients with rectal prolapse who met the diagnostic criteria of rectal prolapse in Yiwu Central Hospital from April 2013 to June 2015 were selected as the research subjects.They were divided into two groups according to random number table, with 30 cases in each group.The observation group used Altemeier, and the control group underwent triple surgery (rectal mucosal ligation, periorbital injection, and anal ring retraction). The total effective rate after surgery was compared and analyzed. Results The operation of the two groups was successfully completed.The total effective rate of the observation group was 96.67%, which was significantly higher than 80.00% of the control group, the difference was statistically significant(χ2=5.856, P=0.048). The Wexner constipation score of the observation group was (1.4±1.6)points, which was significantly lower than that of the control group[(3.2±2.0)points, t=3.849, P<0.05]. The Wexner anal incontinence score of the observation group after 24 months was (2.9±1.8)points, which was significantly lower than that of the control group [(4.4±2.7)points, t=2.532, P<0.05]. The proportions of anastomotic bleeding, pelvic swelling and perianal eczema in the observation group were 0.00%, 0.00% and 3.33%, respectively, which were significantly lower than those in the control group(20.00%, 23.33% and 30.00%,χ2=4.630, 5.822, 7.680, all P<0.05). Conclusion Altemeier can significantly improve the quality of life of patients, with a high cure rate and good clinical results.

关 键 词：直肠脱垂 结肠切除术 治疗结果 便秘 肛门失禁 直肠黏膜排列结扎术 直肠周围注射术 肛门环缩术 

分 类 号：R657.19[医药卫生—外科学]