直肠黏膜环切术治疗直肠前突的临床研究

The clinical study of procedure for prolapse and hemorrhoids in the treatment of rectocele

目的探讨直肠黏膜环切术(PPH)治疗直肠前突患者的临床效果。方法选择本院2013年8月至2016年12月直肠前突患者88例,随机分为治疗组和对照组,每组各44例,对照组实施经直肠闭式黏膜修补术,治疗组实施直肠黏膜环切术,对比两种治疗方法的临床效果。结果治疗组治疗总有效率高于对照组(97.73%vs.68.18%);平均手术时间、住院时间低于对照组;住院期间并发症发生率低于对照组(15.91%vs.50.00%);随访6个月,观察组患者的排便时间、排便的用力程度、排便频次、排便不尽感、手助排便情况的评分与对照组相比较均有明显差异(P<0.05)。检测直肠肛门抑制反射的最小松弛容积(minimum relaxation volume,MRV)、肛管静息压、初始排便阈值、最大排便阈值较对照组有明显下降,直肠最大收缩压较对照组明显提高,差异均有统计学意义(P<0.05)。结论直肠前突患者采用PPH术治疗,操作简单,手术时间短,出血量少,并发症少,复发率低,安全可靠,有一定的临床推广应用价值。

Objective To investigate the clinical effect of procedure for prolapse and hemorrhoids（PPH） in the treatment of rectocele. Methods A Tatol of 88 patients with rectocele were selected in our hospital from Augest,2013 to December,2016,and were randomly divided into the treatment group and the control group,with 44 patients in each group. The control group were treated with rectal mucosal repair,and the treatment group were treated with PPH. The clinical effectness of the two treatment methods were compared. Results The total effective rate in the treatment group was significantly higher than the control group（97.73% vs. 68.18%,P〈0. 05）. The average operative time and length of hospital stay in the treatment group were significantly shorter than the control group（P〈0. 05）. The incidence of complications during hospitalization was lower in the treatment group compared with the control group（15.91% vs.00.00%）,the difference was statistically significant（P〈0. 05）. The recurrence rate in the treatment group was significantly lower than the control group（0.00% vs. 9.09%,P〈0. 05） at 6th month after the operation. The defecation time,the degree of defecation,the frequency of defecation and the frequency of defecation in the treatment group were significantly different from the control group（P〈0. 05）. In the treatment group,the minimum relaxation volume（MRV）,anal resting pressure,initial defecation threshold and maximum defecation threshold were significantly lower,and the maximal systolic blood pressure of the rectum higher,compared.with the control group（P〈0. 05）. Conclusion The patients with rectocele were treated with PPH is relatively simple,and has short operation time,the bleeding volume is small,with fewer complications rate,and lower recovery rate. It is safe and reliable,and worthy of clinical application.