盆底整体理论指导下完全性直肠脱垂的手术疗效分析  

Pelvic floor holistic theory guided complete rectal prolapse manegement

作　　者：吕兵兵 曹永丽 李明 王思远 魏东 Bingbing Lyu;Yongli Cao;Ming Li;Siyuan Wang;Dong Wei(Institute of Anal-Colorectal Surgery,No.989 Hospital of PLA,Luoyang 471031,China)

机构地区：[1]中国人民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6期439-442,共4页Chinese Journal of General Surgery

摘　　要：目的探讨盆底整体理论指导的完全性直肠脱垂手术的临床疗效。方法回顾性分析2015年10月至2019年6月在解放军第九八九医院手术治疗的42例完全性直肠脱垂患者,A组为研究组(n=23),采用腹腔镜盆底修复直肠悬吊联合痔上黏膜环切吻合术;B组为对照组(n=19),采用Altemeier术。结果A组和B组手术时间分别为(53±6)、(90±9)min,术中出血量分别为(14±5)、(80±19)ml,住院时间分别为(8.9±1.7)、(13.5±2.1)d,差异均有统计学意义(均P<0.05)。两组并发症的发生差异有统计学意义(P<0.05)。A组与B组术前直肠脱垂程度分别为(9.5±1.7)、(8.7±1.5)cm,术后6、12、24个月分别为(-1.0±1.6)、(-0.2±1.8)cm;(-1.0±1.3)、(-0.3±1.5)cm;(-0.8±1.2)、(-0.5±1.6)cm,差异均有统计学意义(均P<0.05)。A组与B组术前Wexner便秘评分分别为(6.4±1.7)、(6.4±1.5),术后6、12、24个月分别为(2.8±1.0)、(3.0±1.3);(2.6±1.1)、(2.8±1.3);(2.0±0.9)、(2.3±1.1),差异均有统计学意义(均P<0.05)。A组与B组术前Wexner便失禁评分分别为(7.6±1.7)、(7.1±1.5),术后6、12、24个月分别为(3.7±1.7)、(3.4±1.2);(3.5±1.8)、(3.1±1.1);(3.4±1.9)、(2.6±1.3),差异均有统计学意义(均P<0.05)。结论盆底整体理论指导下的手术方式是治疗完全性直肠脱垂的有效术式。Objective To evaluate pelvic floor holistic theory used in the treatment of complete rectal prolapse(CRP).Methods Forty-two CRP patients at No.989 Hospital between Oct 2015 and Jun 2019 were divided into group A(n=23)treated by laparoscopic rectopexy associated with the procedure for PPH,and group B(n=19),by Altemeier precedure.The degree of rectal prolapse,Wexner fecal incontinence score and Wexner constipation score were evaluated before operation and at the 6th,12th and 24th months after operation Results The operation time of the two groups were(53±6)and(90±9)min;intraoperative blood loss was(14±5)and(80±19)ml;the hospital stay was(8.9±1.7)and(13.5±2.1)d,all P<0.05.There was no significant difference in postoperative recurrence between the two groups(P>0.05).The degree of rectal prolapse in group A and B were(9.5±1.7)and(8.7±1.5)cm;the 6th,12th and 24th months after operation were[(-1.0±1.6),(-0.2±1.8)cm;(-1.0±1.3),(-0.3±1.5)cm;(-0.8±1.2),(-0.5±1.6)cm],all P<0.05.The preoperative constipation in group A and group B was(6.4±1.7)and(6.4±1.5)respectively;the 6th,12th and 24th months after operation were[(2.8±1.0)vs.(3.0±1.3);(2.6±1.1)vs.(2.8±1.3);(2.0±0.9)vs.(2.3±1.1)],all P<0.05.The preoperative fecal incontinence score of group A and group B were(7.6±1.7)vs.(7.1±1.5);the 6th,12th and 24th months after operation were[(3.7±1.7)vs.(3.4±1.2);(3.5±1.8)vs.(3.1±1.1);(3.4±1.9)vs.(2.6±1.3)],all P<0.05.Conclusion Pelvic floor holistic theory help improve the treatment of complete rectal prolapsed.

关 键 词：直肠脱垂 骨盆底 外科手术 治疗结果 

分 类 号：R657.19[医药卫生—外科学]