PPH治疗直肠黏膜内脱垂型便秘手术前后排粪造影检查分析

Analysis on pre and postoperative defecography of treating constipation of internal prolapse of rectal mucosa by PPH

目的:研究吻合器痔上黏膜环切术(PPH)治疗直肠黏膜内脱垂型便秘手术前后排粪造影检查的临床价值。方法:选取医院收治的120例直肠黏膜内脱垂型便秘患者,采用随机数表法将其分为观察组和对照组,每组60例。观察组行PPH治疗,对照组行直肠黏膜柱状缝扎加耻直肌挂线术治疗,两组手术前后均接受排粪造影检查。比较两组患者手术疗效,随访3个月和6个月记录两组Longo评分、便秘Wexner评分、便秘严重程度评分(SS)、视觉模拟量表(VAS)评分及术后6个月复发率,分析排粪造影指标与便秘严重程度的关系。结果:观察组和对照组术后3个月优良率分别为88.33%和70.00%,其差异有统计学意义(x2=6.114,P<0.05);两组术后6个月优良率差异无统计学意义;术后3个月和6个月观察组直肠前突、直肠内套叠及会阴下降距离均低于对照组,差异有统计学意义(t3个月=II.326,t=9.262,t=6.902;t6个月=8.556,t=4.290,t=2.975;P<0.05);术后3个月观察组静息相肛直角显著高于对照组,差异有统计学意义(t=4.163,P<0.05);力排相肛直角及力排时肛直角开大角度均低于对照组,差异均有统计学意义(t=5.690,t=2.076;P<0.05);术后3个月观察组Longo评分、便秘Wexner及SS评分均低于对照组,差异均有统计学意义(t=7.516,t=2.847,t=2.730;P<0.05);观察组术后1d和术后3d VAS疼痛评分低于对照组,差异有统计学意义(t=3.894,t=4.021;P<0.05);观察组术后6个月复发率低于对照组,差异有统计学意义(x2=4.324,P<0.05)。Longo评分、便秘Wexner及SS评分与直肠前突、直肠内套叠、会阴下降深度、力排相肛直角及力排相肛直角开大直角均具有一定相关性(rLongo评分=0.384,r=0.353,r=0.291,r=0.244,r=0.285;r便秘wWexner评分=0.269,r=0.254,r=0.242,r=0.293,r=0.376;rSS评分=0.377,r=0.237,r=0.301,r=0.323,r=0.402;P<0.05)。结论:PPH治疗直肠黏膜内脱垂型便秘能显著改善便秘症状,效果肯定,排粪造影有助于评估PPH治疗效果,为临床干预提供参考。

Objective:To study the clinical value of pre and postoperative defecography of treating constipation of internal prolapse of rectal mucosa by procedure for prolapse and hemorrhoids(PPH).Methods:120 patients with constipation of internal prolapse of rectal mucosa were enrolled in this study and they were divided into observation group(60 cases)and control group(60 cases)according to random number table method.The patients of observation group were treated with PPH,while the patients of control group were treated with rectal mucosa columnar suture and rectus pubis thread-drawing.Both two groups received pre and postoperative defecography examination.The curative effect of two groups was compared.And the Longo score,Wexner score of constipation,severity score(SS)of constipation,the score of visual analogue scoring(VAS)and recurrence rate postoperative 6 month were recorded at the 3 th month and the 6 th month of follow-up.And the relation of the indicators of defecography and the severity of constipation was further analyzed.Results:The difference of the excellent and good rate at the 3 th month post operation between observation group(88.33%)and control group(70.00%)was significant(x^2=6.114,P<0.05).There was no significant difference in the excellent and good rate between the two groups at the 6 th months post operation.The rectocele,rectal intussusception and the distance of perineal descent of observation group were significantly lower than those of control group at 3 th months and 6 th months post operation(t=11.326,t=8.556,t=9.262,t=4.290,t=6.902,t=2.975,P<0.05),respectively.And the resting rectal angle of observation group was significantly higher than that of control group at the 3 th months post operation(t=4.163,P<0.05),while the force row phase anal right angle and the force row phase anal right angle wide angle of observation group were significantly lower than those of control group at the 3 th months post operation(t=5.690,t=2.076,P<0.05),respectively.The Longo score,Wexner score and SS scores of constipation of observation group were significantly lower than those of control group at the 3 th months post operation(t=7.516,t=2.847,t=2.730,P<0.05),respectively.The VAS pain scores of observation group at the 1 th and 3 th day post operation were significantly lower than those of control group(t=3.894,t=4.021,P<0.05).The recurrence rate of observation group was significantly lower than that of control group at 6 th months post operation(x^2=4.324,P<0.05).The Longo were correlated with rectocele,rectal intussusception,descent depth of perineum,the force row phase anal right angle and the force row phase anal right angle wide(r=0.384,r=0.353,r=0.291,r=0.244,r=0.285,P<0.05).And Wexner scores were correlated with rectocele,rectal intussusception,descent depth of perineum,the force row phase anal right angle and the force row phase anal right angle wide(r=0.269,r=0.254,r=0.242,r=0.293,r=0.376,P<0.05).And the SS scores were correlated with rectocele,rectal intussusception,descent depth of perineum,the force row phase anal right angle and the force row phase anal right angle wide(r=0.377,r=0.237,r=0.301,r=0.323,r=0.402,P<0.05).Conclusion:The PPH can significantly improve the symptoms of constipation in treating constipation of internal prolapse of rectal mucosa and its effect is worthy to be acknowledged.Defecography is helpful to assess the therapeutic effect of PPH and provide reference for clinical intervention.