直肠前突与出口梗阻性便秘的关系

The Relationship between Anterior Rectocele and Outlet Obstructive Constipation

目的探讨直肠前突与功能性出口梗阻性便秘的关系及临床意义。方法回顾性分析417例功能性出口梗阻性便秘患者的临床和动态排粪造影资料。对直肠前突病例的力排过程进行动态回放,并分析其表现。结果①310例有直肠前突,392例有直肠内脱垂,353例有会阴下降,69例有盆底痉挛或耻直肌肥厚。95.20%(397/417)的病例至少存在两种异常,无单发直肠前突病例。男女患者间比较,直肠前突、会阴下降、盆底痉挛或耻直肌肥厚的发生率差异均有统计学意义(P<0.01),但直肠内脱垂的发生率差异无统计学意义(P>0.05)。②直肠前突病例力排过程动态回放:直肠内钡剂排空或接近排空、直肠远端增粗粘膜堆积226例,占72.90%;直肠内钡剂不排或呈滴状排出、远端粘膜脱入肛管和(或)盆底痉挛或耻直肌肥厚71例,占22.90%;前突囊袋缩小不明显、囊袋后方直肠内脱垂13例,占4.20%。结论直肠前突不是引起便秘的主要原因,明确直肠前突与功能性出口梗阻性便秘的关系对临床制定治疗方案有指导意义。

Objective To discuss the relationship and clinical significance between anterior rectocele and resultant constipation by the obstruction of functional oudet. Methods The clinical and dynamic defecography materials of 417 cases with resultant constipation by the obstruction of functional outlet were retrospectively reviewed. Dynamically replaying the cases of anterior rectocele and analyzed the representation. Results ①310 cases with anterior rectocele, 392 cases with internal rectal prolapse, 353 cases with perineum descending, 69 cases with pelvic spasm or puborectalis thickening. 95.20% （397/417） cases with more than 2 abnormalities simultaneously, no cases with only anterior rectocele. The difference between men and women was statistically significant（P〈 0.01 ） of anterior rectocele,perineum descending,pelvic spasm or puborectalis thickening. There was no difference with internal rectal prolapse（P 〉 0.05 ）. ②Dynamically replaying the cases of anterior rectocele：226 cases could drain almost all of the barium of rectum and the distal rectum mucosal fold hypertrophy,account for 72.90% （226/310）;71 cases could not drain any or drained driply and prolapse of rectal mncosa or pelvic spasm or puborectalis thickening, account for 22.90 % （71/310 ）;13 cases with protruded sac reduced not obsolete and rearward the sac internal rectal prolapse, account for 4.20% （13/310）. Conclusion Anterior rectocele is not the main cause of constipation, to makc sure the relationship between anterior rectocete and resultant constipation by the obstruction of functional oudet can provide instructional significance for the cure scheme.