经腹会阴联合手术治疗出口梗阻型便秘的疗效观察

Transabdominal Combined with Transperineal Surgery in the Treatment of Outlet Obstruction Constipation： Efficacy Observation

为探讨经腹会阴联合手术治疗出口梗阻型便秘（OOC）的疗效,回顾性分析2010年10月至2016年10月于我科行经腹会阴联合手术治疗的62例出口梗阻型便秘患者资料,患者均伴有不同程度的直肠前突和直肠黏膜内脱垂.腹部手术：术中均行Pfannenstiel切口（腹部横行半月状切口）,均应用补片消除盆腔入口,15例患者加行网膜成形术覆盖补片,2例直肠内套叠患者加行直肠固定术,24例患者在补片下加以垂直缝合.会阴手术：29例患者行经肛门直肠前突修补和直肠黏膜内脱垂手术,16例行经阴道肛提肌成形术,17例行黏膜烧灼折叠术.结果显示,本组62例患者中,治愈47例（75.8%）,好转12例,无效3例,总有效率为95.2%.术后4个月下腹不适、会阴下坠2例,为盆腔包裹性积液所致;术后第6年排尿困难、腰部不适1例,静脉肾盂造影检查示肾盂扩张,予以手术解除左侧输尿管因粘连而导致的狭窄,术中证实不是补片压迫所致.结果表明,经腹会阴联合手术治疗出口梗阻型便秘安全可行,疗效确切,并发症少.

In order to explore the efficacy of transabdominal combined with transperineal surgery in the treat- ment of outlet obstruction constipation （OOC）, the data of 62 patients with OOC admitted in authorls de- partment from oct. 2010 to oct. 2016 and treated with transabdominal combined with transperineal surgery were analyzed retrospectively. All patients were accompanied by varying degrees of rectocele and prolapse of rectal mucosa. Abdominal surgery： perfomed Pfannenstiel incision （abdominal transverse meniscus inci- sion） during the operation, and used the patch to eliminate the pelvic cavity inlet; 15 patients performed omentoplasty and covered patch, 2 cases of rectal internal intussusception performed rectal fixation, 24 pa- tients performed vertical suture under the patch. Perineal surgery： 29 patients underwent transanal recto- cele repair and internal rectal mucosal prolapse surgery, 16 cases underwent levator ani plasty, 17 cases performed mucosal burning fold. As results, among 62 patients, 47 cases （75.8%） were cured, improved in 12 cases, no response in 3 cases; the total effective rate was 95.2%. 4 months after operation, the lower abdomen discomfort and perineat fall was in 2 cases, caused by pelvic encapsulated effusion; 6 years after operation, the difficulty of urination and waist discomfort in 1 case; intravenous pyelography showed pyel- ectasis and performed surgery to lift the stenosis due to adhesion of the left ureter. The operation con- firmed that it was not caused by patch pressure. The results showed that transabdominal combined with transperineal surgery in the treatment of OOC was safe and feasible, the curative effect was definite and the complication was less.