经阴道纵切横缝术修补直肠前突的临床研究

Repair Rectocele with Longitudinal Incision and Transverser Suture on the Vaginal Posterior Wall

目的 提高直肠前突所致出口梗性便秘的治疗效果 ,减少直肠前突修补术的术后并发症、后遗症。方法 总结国内外经验 ,在目前经阴道修补直肠前突经典术式基础上改良设计“经阴道纵切横缝术”治疗直肠前突 ,按国内暂行诊治标准[1] 纳入观察组 5 2例 ,历史对照组 5 8例 ,观察组在腰俞穴麻醉下经阴道后壁粘膜皮肤交界处切口入路作长约 3cm的阴道纵切口 ,游离粘膜分离出直肠阴道膈肌肉并作荷包缝合 ,然后将阴道切口最上缘与阴道外口皮肤缝合 ,使纵切口变为横缝合切口 ,术后预防性应用抗菌素 ,局部清洁换药至愈。结果 5 2例 ,仅 1例无效 ,平均疗程 11± 2 .1天 ,总有效率 98.1% ,无感染及明显后遗症。结论 本疗法具有疗效好、痛苦少、疗程短 。

Obiective The research aim of repair rectocele is to raise cure rate of constipation of the Outlet-obstruction type caused by rectocele and to reduce the postoperative complication of repairing operation of rectocele. METHODS: 52 cases with rectocele were indentified in our institution over a period from March,1999 to March,2002.The applicant for the treatment of rectocele is a self-design operation by using Longitudinal incision and transverser stuture on the vaginal posterion wall.We longitudinaly incised muscosa on the vaginal about 3cm and divided mucosa and show the vaginal muscle, a purse-sering suture with Catgut was done then transverser suture mucosa and derma. RESULTS: of 52 cases ,only one case (1.9%) have no effect, complete cure was obtained in 37 cases (71%),marked effect in 10(19%),improvement in 4(8%).The total effective rate reached 98.1% and the mean curative period was 11±2.1 days.There was one case (1.9%) have postoperative complication . CONCLUSION: Compared with MS group, the LO group has great advantages of less surgical injury,shortenting treatment course, raising cure rate and reduceing the postoperative complication.