经肛吻合器直肠黏膜切除术与经直肠闭式修补术治疗直肠前突的对比研究

Comparison of Procedure for Prolapse and Hemorrhoids and Block Repair Procedure in Treatment for Rectocele

目的比较经肛吻合器直肠黏膜环形切除术(procedure for prolapse and hemorrhoids,PPH)与经直肠闭式修补术(Block)治疗直肠前突的临床疗效。方法对2008年9月至2010年9月期间我院手术治疗的62例直肠前突患者的临床资料进行回顾性分析,根据手术方式的不同分为PPH组(n=32)和Block组(n=30)。对2组患者手术后症状改善情况进行Longo’s出口梗阻型便秘(ODS)评分,并对手术时间、术中出血量、术后疼痛评分、需用止痛药次数、术后并发症、住院时间及住院费用进行比较。结果 2组患者术后排便困难症状均有明显改善。Longo’sODS评分PPH组术后1个月与术后3个月比较,差异无统计学意义(P>0.05),Block组术后3个月明显高于术后1个月(P<0.01)。2组患者术后1个月和术后3个月Longo’s ODS评分、手术时间、术中出血量、术后疼痛评分、需用止痛药次数及住院时间方面PPH组均明显少于Block组(P<0.01);但PPH组的治疗费用明显多于Block组(P<0.01)。在PPH组患者中,术后出现2例轻度肛门失禁,随访至术后3个月时完全恢复。结论 PPH治疗直肠前突与Block一样安全、有效,从近期疗效上看,优于Block手术且复发率较低。

Objective To compare the therapeutic effect of procedure for prolapse and hemorrhoids（PPH） and Block repair procedure for rectocele.Methods A retrospective study of 62 patients with surgical treatment for rectocele was analyzed.The patients were divided into PPH group（n=32） and Block group（n=30） according to the different operation procedure.The symptoms score of improvement of the patients after surgery was compared between the two groups,including operation time,intraoperative blood loss,postoperative pain score,required analgesic times,postoperative complications,hospitalization time,and hospitalization expenses.ResultsThe symptoms of constipation of patients in two groups was significantly improved afer operation.Comparing one month with three months of Longo＇s obstructed defecation syndrome（ODS） score after the operation,there was no significant difference in the PPH group（P0.05）,but significant difference in the Block group（P0.01）.Although the expenses of the PPH group was much higher than that of the Block group（P0.01）,the outcomes of the PPH group were much better than those of the Block group（P0.01）,including the postoperative Longo＇s ODS score of one month and three months,operation time,intraoperative blood loss,postoperative pain score,required analgesic times,and hospitalization time.Two cases of lightly postoperative incontinence occurred in the PPH group,but completely recovered after three months in the clinical follow-up.ConclusionsThe PPH is as safe and effective as Block repair procedure for rectocele.The short time effect and lower recurrence rate of the PPH are better than those of the Block repair procedure.