盆底整体理论指导的腹腔镜盆底韧带修复治疗女性直肠内脱垂的疗效分析  

Integral theory-guided laparoscopic pelvic floor/ligament repair in the treatment of women's internal rectal prolapse

作　　者：杨阳 曹永丽 张远耀 石守森 杨维维 赵楠 王信琛 张文丽 魏东 Yang Yang;Cao Yongli;Zhang Yuanyao;Shi Shousen;Yang Weiwei;Zhao Nan;Wang Xinchen;Zhang Wenli;Wei Dong(Institute of Anal-Colorectal Surgery,the 989th Hospital of the Joint Logistics Support Force of PLA,Luoyang 471031,China)

机构地区：[1]解放军联勤保障部队第九八九医院全军肛肠外科研究所,洛阳471031

出　　处：《中华普通外科杂志》2022年第5期361-365,共5页Chinese Journal of General Surgery

基　　金：河南省医学科技攻关计划项目(2011030031)。

摘　　要：目的:对比分析腹腔镜盆底韧带整体修复联合痔上黏膜环切术和单纯腹腔镜盆底韧带整体修复术治疗女性直肠内脱垂的临床疗效。方法:收集63例行单纯腹腔镜盆底韧带整体修复术(A组)和67例行腹腔镜盆底韧带整体修复联合痔上黏膜环切术(B组)的女性直肠内脱垂患者的临床资料,比较两组患者术前和术后6个月、2年、5年的直肠内脱垂程度(DIRP)、Wexner便秘评分(WCS)、Wexner肛门失禁评分(WIS)及胃肠生活质量指数(GIQLI)。结果:两组的术前排便次数、DIRP、WCS、WIS、GIQLI比较差异均无统计学意义(均P>0.05)。与术前比较,术6个月、2年和5年两组DIRP、WCS、WIS、GIQLI均明显改善(均P<0.001)。B组在术后6个月、2年和5年的WCS、WIS、GIQLI及术后6个月、术后5年的DIRP均明显优于A组(均P<0.05)。两组术后第5年复发率差异有统计学意义(P=0.001)。结论:盆底整体理论指导下的腹腔镜盆底韧带整体修复联合痔上黏膜环切术治疗女性直肠内脱垂治愈率高,临床疗效优于单纯的腹腔镜盆底韧带整体修复术。Objective To compare the clinical efficacy of laparoscopic integral pelvic floor/ligament repair(IPFLR)combined with a procedure for prolapse and hemorrhoids(PPH)and that laparoscopic IPFLR alone in the treatment of internal rectal prolapse(IRP)in women.Methods Patients were divided into groups A in which 63 patients undergoing laparoscopic IPFLR alone,and group B of 67 patients reciving laparoscopic IPFLR combined with PPH.The degree of internal rectal prolapse(DIRP),Wexner constipation scale(WCS)score,Wexner incontinence scale(WIS)score,and Gastrointestinal Quality of Life Index(GIQLI)score were compared between these two groups and in each group those before surgery and 6 months,2 years,and 5 years after surgery.Results The number of bowel movements,DIRP,WCS score,WIS score,and GIQLI score before surgery were not significantly different between the two groups(all P>0.05).The DIRP,WCS score,WIS score,and GIQLI score in each group 6 months,2 years,and 5 years after surgery in both two groups were significantly better than those before surgery(all P<0.001).The DIRP,WCS score,WIS score,and GIQLI score in group B were significantly better than those in group A at 6 months,2 years,and 5 years after surgery(all P<0.05)except DIRP at 2 years after surgery(all P<0.05).There was a significant difference in the recurrence rate of IRP between the two groups when evaluated at 5 years after surgery(P=0.001).Conclusions Integral theory-guided laparoscopic IPFLR combined with PPH has a higher cure rate and a better clinical efficacy than laparoscopic IPFLR alone.

关 键 词：直肠脱垂 骨盆底 韧带 修复外科手术 

分 类 号：R657.1[医药卫生—外科学]