吻合器痔上黏膜环切术与直肠黏膜柱状缝扎术治疗出口梗阻型便秘的临床疗效对比

The clinical treatment contrast between procedure for prolapse and hemorrhoids and rectal mucosa columnar ligation for outlet obstruction constipation

目的比较吻合器痔上黏膜环切术和直肠黏膜柱状缝扎术治疗直肠黏膜脱垂导致的出口梗阻型便秘的临床疗效。方法选择2011年10月-2012年10月在新疆医科大学第一附属医院接受手术治疗的出口梗阻型便秘的患者260例,其中吻合器痔上黏膜环切术(PPH)130例(研究组),传统直肠黏膜柱状缝扎术130例(对照组)。对比两组手术方式的治愈率、手术时间、术后24h疼痛评分、痊愈时间、术前术后排便时间、术前术后直肠肛管测压等疗效及术后定期随访1、3、6、12个月的排便评分情况。结果研究组的治愈率为83.85%(109/130),对照组的治愈率为73.08%(95/130),两组比较差异有统计学意义(P<0.05)。研究组的手术时间、术后24h疼痛评分、痊愈时间均优于对照组,差异具有统计学意义(P<0.05)。研究组术后排便时间明显短于术前排便时间,差异有统计学意义(P<0.05),研究组术后肛管舒张压、肛管最大收缩压、肛管静息压、直肠静息压与术前比较差异无统计学意义(P>0.05)。对照组术后排便时间明显短于术前,差异有统计学意义(P<0.05),对照组术后肛管舒张压、肛管最大收缩压、肛管静息压与术前比较差异有统计学意义(P<0.05),对照组术后直肠静息压与术前比较差异无统计学意义(P>0.05)。研究组与对照组手术后1、3个月排便差异无统计学意义(P>0.05),6、12个月研究组与对照组排便差异具有统计学意义(P<0.05)。结论 PPH术式治疗直肠粘膜脱垂引发的出口梗阻型便秘的手术疗效及近远期效果都优于传统直肠黏膜柱状缝扎术,更能有效地改善患者便秘情况和提高患者生活质量,应该成为治疗直肠黏膜脱垂导致的出口梗阻型便秘的首选术式。

Objective To compare the effect of procedure for prolapse and hemorrhoids and rectal mucosa columnar ligation for outlet obstruction constipation.Methods 260 patients who underwent the surgery of outlet obstruction constipation from the First Affiliated Hospital of Xinjiang Medical University were collected from October 2011 to October 2012,of which 130 patients accepted the procedure for prolapse and hemorrhoids（PPH）as study group and 130 patients accepted the traditional rectal mucosa columnar ligation as control group.The curative effect were compared between two groups by surgical cure rate,operation time,postoperative 24 hpain scores,efficacy and postoperative recovery time,preoperative and postoperative defecation time,preoperative and postoperative anorectal manometry,and the regular defecation scores followed-up after operation 1,3,6,12 months.Results The cure rate in the study group was83.85%（109/130）and in the control group was 73.08%（95/130）,and the difference was statistically significant（P〈0.05）.Operative time,postoperative 24 hpain score,recovery time of the study group were better than that of the control group,and the differences were statistically significant（P〈0.05）.In study group,postoperative defecation time was significantly better than the preoperative defecation time,and the difference was statistically significant（P〈0.05）;In the study group,compared with preoperation,postoperative anal diastolic pressure,anal maximum systolic blood pressure,anal resting pressure,rectal resting pressure preoperative were not statistically different（P〉0.05）.In the control group,the postoperative defecation time was significantly better than the preoperative defecation time,and the difference was statistically significant（P〈0.05）.In the control group,the anal canal diastolic blood pressure,anal canal maximum diastolic blood pressure,anal canal resting pressure were different between post operation and before operation,and the difference was statistically significant（P〈0.05）,while the postoperative rectal resting pressure did not changed（P〉0.05）.and the regular follow-up after operation 1,3months,the study group and the control group was not statistically significant difference defecation（P〉0.05）,of the study group and the control group was statistically significant difference defecation（P〈0.05）,defecation,the was not statistically significant,group 6and 12 months of defecation between study group and the control group has statistical significance（P〈0.05）.There was no statistical difference in defecation between the study group and the control group after surgery 1 month,3 months（P〉0.05）,while after 6months,12 months,the differences had statistically significant（P〈0.05）.Conclusion PPH surgery for outlet obstruction constipation caused by pralapseofrectalmucosa is superior to traditional rectal mucosa columnar joint surgery not only at the recent effect of the surgery treatment,but also at the long time curative effect.PPH surgery can effectively improve symptom of constipation and improve the life quality of constipation patients,which should be a prefer treatment for outlet obstruction constipation caused by prolapseofrectalmucosa.