经会阴吻合器直肠脱垂切除术与改良Altemeiers术治疗完全性直肠脱垂疗效比较

Comparison of the effect between perineal stapled prolapse resection and modified Altemeier's procedure in treatment of complete rectal prolapse

目的比较经会阴吻合器直肠脱垂切除术(PSPR)与改良Altemeiers术治疗完全性直肠脱垂的临床效果。方法选择2014年3月至2016年11月漯河市中医院收治的30例完全性直肠脱垂患者为研究对象,根据手术方法将患者分为PSPR组和改良Altemeiers术组,每组35例。记录2组患者的手术时间、术中出血量、切除直肠长度及住院时间; 2组患者分别于术前和术后2个月采用Wexner评分法进行肛门失禁评分,并测定肛门静息压;所有患者术后随访1 a,观察并发症及直肠脱垂复发情况。结果 PSPR组患者手术时间显著短于改良Altemeiers术组,术中出血量显著少于改良Altemeiers术组(P<0.05); 2组患者切除直肠长度及住院时间比较差异无统计学意义(P>0.05)。2组患者术前Wexner评分及肛门静息压比较差异无统计学意义(P>0.05);与术前比较,术后2组患者Wexner评分显著降低,肛门静息压显著升高(P<0.05); 2组患者术后Wexner评分及肛门静息压比较差异均无统计学意义(P>0.05)。PSPR组和改良Altemeiers术组患者术后并发症发生率分别为8.57%(3/35)、14.29%(5/35),PSPR组患者术后并发症发生率低于改良Altemeiers术组(χ~2=6.672,P<0.05)。2组患者术后1 a均未发生直肠脱垂复发。结论 PSPR与改良Altemeiers术治疗完全性直肠脱垂的疗效相当,但PSPR具有手术时间短、术中出血量少、术后并发症发生率低等优势。

Objective To compare the clinical effect of perineal stapled prolapse resection (PSPR) and modified Altemeier′s procedure in treatment of complete rectal prolapse. Methods Thirty patients with complete rectal prolapse admitted to Luohe Hospital of Traditional Chinese Medicine from March2014 to November2016 were selected as the study objects.The patients were divided into PSPR group and modified Altemeier′s procedure group according to the operation methods,with35 cases in each group.The operation time, intraoperative bleeding volume,length of resected rectum and hospitalization time were recorded.Anal incontinence was scored by Wexner score before operation and two months after operation,and the anal resting pressure was measured.All patients were followed up for one year to observe the complications and recurrence of rectal prolapse. Results Compared with the modified Altemeier′s procedure group,the operation time was significantly shortened,and the intraoperative bleeding volume was significantly decreased in the PSPR group ( P <0.05).There was no significant difference in the length of resected rectum and hospitalization time between the two groups ( P >0.05).There was no significant difference in Wexner score and anal resting pressure between the two groups before operation ( P >0.05).Compared with pre-operation,the Wexner score was significantly lower and the anal resting pressure was significantly higher after operation in the two groups ( P <0.05).There was no significant difference in Wexner score and anal resting pressure between the two groups after operation ( P >0.05).The incidence of postoperative complications in the PSPR group and modified Altemeier′s procedure group was 8.57%(3/35) and14.29%(5/35),respectively.The incidence of postoperative complications in the PSPR group was lower than that in the modified Altemeier′s procedure group (χ^2= 6.672, P <0.05).No recurrence of rectal prolapse occurred within one year after operation in the two groups. Conclusion The clinical effect of PSPR is similar to that of modified Altemeier′s procedure in the treatment of complete rectal prolapse,but PSPR has the advantages of shorter operation time, less intraoperative bleeding and lower incidence of postoperative complications.