吻合器痔上黏膜环切术治疗出口梗阻性便秘的临床效果观察

Effect of PPH combined with rectal mucosa columnar suture and transvaginal repair on postoperative pain score,longods score and long-term efficacy of patients with outlet obstructive constipation

目的探讨吻合器痔上黏膜环切术(procedure for prolapse and hemorrhoids,PPH)联合直肠黏膜柱状缝扎术及经阴道修补术治疗出口梗阻性便秘的临床效果。方法选择2015年8月至2016年9月山东省枣庄市中医医院收治的74例女性出口梗阻性便秘患者,随机分为观察组和对照组,每组37例。对照组患者接受直肠黏膜柱状缝扎术及经阴道修补术治疗,观察组患者接受PPH联合直肠黏膜柱状缝扎术及经阴道修补术治疗。比较两组术前及术后12、24h的疼痛视觉模拟量表(visual analogue scale,VAS)评分,两组手术前后的直肠肛管测压指标(包括肛管最大收缩压、肛管舒张压、肛管静息压、直肠静息压)及术后各项临床指标(包括排便时间、愈合时间、住院时间),采用Longo ODS评分调查两组患者术前及术后1、3、6、12个月时的排便情况,并记录术后1、2、3年的并发症及复发情况。结果两组术前VAS评分比较差异无显著性(P>0.05),两组术后12、24h的VAS评分均低于术前,且观察组低于对照组,差异有显著性(P<0.05)。两组术前的直肠肛管测压指标比较差异无显著性(P>0.05);对照组术后肛管最大收缩压、肛管舒张压、肛管静息压明显低于术前,差异有显著性(P<0.05),而直肠静息压与术前比较差异无显著性(P>0.05);观察组术后直肠肛管测压指标与术前比较无明显变化(P>0.05)。观察组术后排便时间、愈合时间及住院时间均明显低于对照组,差异有显著性(P<0.05)。两组术前Longo ODS评分比较差异无显著性(P>0.05),术后1、3、6、12个月的Longo ODS评分均明显低于术前,且观察组明显低于对照组,差异有显著性(P<0.05)。两组术后并发症发生率比较差异无显著性(P>0.05),而观察组术后2年及3年复发率明显低于对照组,差异有显著性(P<0.05)。结论PHH联合直肠黏膜柱状缝扎术及经阴道修补术治疗出口梗阻性便秘能够明显减轻疼痛,促进肛门功能恢复,缩短住院时间,近远期疗效显著,应用价值较高。

Objective To analyze the effects of PPH(procedure for prolapse and hemorrhoids)combined with rectal mucosal columnar suture and transvaginal repair on postoperative pain score,Longods score(defecation score)and long-term efficacy in patients with outlet obstructive constipation.Method Seventy-four female patients with outlet obstructive constipation who were treated in our hospital from August 2015 to September 2016 were included in the study and randomly divided into two groups.The control group(37 cases)was given rectal mucosal columnar suture and transvaginal repair,and the experimental group(37 cases)was combined with PPH on this basis.The postoperative pain of the two groups was investigated by VAS score.The anal function indexes of the two groups before and after treatment were counted.The clinical indexes of the two groups were recorded.Postoperative follow-up was conducted and Longods score was used to investigate defecation before and after the operation,and long-term postoperative recurrence and complications were recorded.Result The VAS scores of the experimental group were lower than those of the control group 12 hours and 24 hours after operation,and the difference was statistically significant(P<0.05).Compared with various indexes of anal function,there was no obvious change before and after treatment in the experimental group,with little difference(P>0.05).In terms of defecation time,healing time and other clinical indicators,the experimental group was lower than the control group,the difference was statistically significant(P<0.05).Longods scores at 6 and 12 months after operation in the experimental group were significantly lower than those in the control group,and the difference was statistically significant(P<0.05).The recurrence rate in 2 and 3 years after operation in the experimental group was significantly lower than that in the control group,and the difference was statistically significant(P<0.05).Conclusion PHH combined with rectal mucosal columnar suture and transvaginal repair in the treatment of outlet obstructive constipation can significantly reduce physiological pain,promote the recovery of anal function,shorten the hospitalization time,and has significant short-term and long-term curative effect and high application value.