Delorme联合肛门环缩术配合益气养阴法治疗成年人完全性直肠脱垂的临床疗效分析  

Clinical efficacy of Delorme plus thiersch technique combined with Yiqi Yangyin decoction in the treatment of complete rectal prolapse in adults

作　　者：沈晓[1] 姚一博[1] 尹璐 陆金根[1] 王琛[1] Shen Xiao;Yao Yibo;Yin Lu;Wang Chen(Department of Anorectal Surgery,Longhua Hospital of T.C.M,Shanghai 200032,China)

机构地区：[1]上海中医药大学附属龙华医院肛肠科,上海200032

出　　处：《中华临床医师杂志（电子版）》2022年第7期614-620,共7页Chinese Journal of Clinicians(Electronic Edition)

基　　金：上海市申康临床创新项目(SHDC22021316-A);上海市临床重点专科项目(SHSLCZDZK04301);上海中医药大学杏林学者追踪计划(RC2017208)。

摘　　要：目的探讨Delorme联合肛门环缩术配合益气养阴法治疗成年人完全性直肠脱垂的临床疗效和影响愈后的关键因素。方法回顾性分析上海中医药大学附属龙华医院肛肠科从2018年1月~2021年12月采用Delorme联合肛门环缩术配合益气养阴法治疗完全性直肠脱垂19例患者的资料,其中男性9例,女性10例。结合肛门直肠测压、Wexner肛门失禁评分评价术前、术后3个月患者的肛门功能。结果19例直肠脱垂患者顺利完成Delorme联合肛门环缩术,术后益气开秘方加减内服。所有患者均未发生术后出血、吻合口感染、直肠穿孔等并发症。所有患者全部成功随访,随访时间3~48个月。术后3月治愈率为100%,随访期(术后6个月以上)患者治愈率为78.95%,好转率为21.05%。患者术后3个月肛管静息压和肛管最大收缩压均高于术前(P<0.05)。女性患者术后3个月的Wexner肛门失禁评分(P<0.05)较术前改善。结论Delorme联合肛门环缩术治疗完全性直肠脱垂安全有效、并发症少,配合中药内服,内外兼治,可以改善术后排便症状和肛门失禁,促进肛门功能的恢复,患者满意度好。Objective To evaluate the clinical efficacy of Delorme-Thiersch procedure and Yiqi Yangyin decoction in the treatment of complete rectal prolapse in adults and identify key factors affecting the healing process.Methods A retrospective analysis was performed on the data of 19 patients with complete rectal prolapse who underwent Delorme's plus Thiersch's procedure with Yiqi Yangyin decoction at the Department of Anorectal Surgery,Longhua Hospital,Shanghai University of Traditional Chinese Medicine from January 2018 to December 2021.Anal rectal pressure measurements and Wexner anal incontinence scores were used to evaluate anal function in patients before and 3 months after surgery.Results Nineteen patients with rectal prolapse successfully completed this treatment.All patients had no complications such as postoperative bleeding,anastomotic infection,or rectal perforation.The patients were followed for 3 to 48 months.The healing rate at 3 months postoperatively;the overall healing rate at 6 months after operation was 78.95%,and the improvement rate was 21.05%.The Wexner anal incontinence score improved significantly in female patients at 3 months postoperatively compared to the preoperative score(P<0.05).Resting anal canal pressure and maximal anal canal systolic pressure were both higher at 3 months postoperatively than before operation(P<0.05).Conclusion Delorme's plus Thiersch's procedure is safe and effective in the treatment of complete rectal prolapse,with mild acceptable complications.Delorme's plus Thiersch's procedure combined with Yiqi Yangyin decoction can reduce postoperative symptoms,improve anal incontinence,and promote the recovery of anal function.

关 键 词：直肠脱垂 Delorme手术 肛门环缩术 益气养阴 肛门功能 

分 类 号：R657.1[医药卫生—外科学]