改良Block手术治疗直肠前突型便秘

Modified Block＇s Repair for Rectocele Constipation

为探讨改良Block修补术治疗直肠前突型便秘的治疗效果和手术适应症，将68例直肠前突型便秘病人分为试验组和对照组。试验组36例采用改良Block修补术治疗，对照组32例采用经典Block修补术治疗，观察两组病例的术后并发症、治愈时间、排便情况、术后肛门外形有无畸形、术后复发及手术治疗效果。结果显示，试验组总有效率为97．2％（35／36），其中治愈率为72．2％（26／36），显效率为13．9％（5／36），有效率为11．1％（4／36）；对照组总有效率为84．4％（27／32），其中治愈率为53．1％（17／32），显效率为9．4％（3／32），有效率为21．9％（7／32）。两组手术治愈率和显效率，试验组（86．1％）显著优于对照组（62．5％）（P〈0．05）。术后随访0．5～3年，试验组未见便秘复发，对照组有4例便秘复发。结果表明，试验组改良Block修补术具有如下优点：（1）手术适应症较Block修补术范围广，各型直肠前突型便秘均可采用改良Block修补术治疗。（2）治疗效果好，复发率低。（3）术野显露清楚，操作简便。（4）术中切开肛门后方皮肤、黏膜、内外括约肌至耻骨直肠肌，愈合后可使肛门口向后移位，重建肛管直肠角。（5）各种不同原因引起便秘的疾病可同时手术处理，肛门狭窄者可采用改良Block修补术。

For the aim of exploring the curative effect and indication of modified Block＇s repair for rectocele constipation authors divided the 68 patients into trial group（ n =36） and controlled group（ n =32）. Trial group received the modified procedure, controlled group received the classical one. Then ,postoperative complication,cure time, defecation status, postoperative anal form, postoperative recurrence and therapeutic effect of both groups were observed and noticed. As results, in trial group total effective rate was 97.2% （35/36）, cure rate 72.2%（26/36）,excellent rate 13.9%（5/36）,response rate 11. 1% （4/36）;in controlled group those indexes were 84.4%（27/32） ,53.1（17/32） ,9.4（3/32） ,21.9% （7/32） ,respectively. Thus there was a significant difference in the cure rate and excellent rate between both groups（ P 〈0.05）. No constipation recurrence was found within postoperative follow-up of 0.5-3 yr. in trial group,while in controlled group recurrence of 4 cases was found. Results show the modified procedure has following advantages： 1）it＇s indication is more extensive than the classical one,it indicates various types of rectocele constipation; 2） better therapeutic effect and lower recurrence rate; 3） it has wide operative field, and its manipulation is simple;4）the opening of anus turns to the back after healing of incisal skin, mucosa, internal ＆ external sphincter,as well puborectalis,so that could reconstructing the anorectal angle;5）it can operate to treat the disease which induced constipation in same time and can repair anal stenosis usually induced by other operation.