吻合器痔上黏膜环切术治疗直肠黏膜脱垂所致出口梗阻型便秘的近远期疗效观察

Observation of the Short-term and Long-term Efficacy of Procedure for Prolapse and Hemorrhoids in the Treatment of Obstructed Defecation Syndrome Caused by Rectal Mucosal Prolapse

目的探讨吻合器痔上黏膜环切术(PPH)治疗直肠黏膜脱垂所致出口梗阻型便秘(ODS)的疗效。方法将2016年1月至2017年12月云南省红河州哈尼族彝族自治州第一人民医院收治的102例直肠黏膜脱垂所致ODS患者,采用随机数表法分成试验组和对照组,每组各51例。对照组采用直肠黏膜套扎术,试验组采用PPH治疗。评估两组围术期指标(手术时间、术后1 d疼痛、首次排便时间、住院时间)和治疗12个月后疗效,比较两组治疗前后症状积分、肛肠动力学(肛管收缩压、静息压)。结果1)试验组手术时间、术后1 d疼痛、首次排便时间和住院时间均低于对照组(P<0.05);2)治疗12个月后,试验组显效率高于对照组(P<0.05);3)治疗3、12个月后,两组症状积分均低于治疗前(P<0.05),试验组治疗各时间点症状积分均低于对照组(P<0.05);4)治疗3个月后,对照组肛管收缩压、静息压均低于治疗前(P<0.05),试验组治疗前后肛管收缩压、静息压比较差异无统计学意义(P>0.05)。结论PPH治疗直肠黏膜脱垂所致ODS效果近远期疗效和安全性均良好。

Objective To explore the efficacy of procedure for prolapse and hemorrhoids(PPH)in the treatment of obstructed defecation syndrome(ODS)caused by rectal mucosal prolapse.Methods A total of 102 patients with ODS caused by rectal mucosal prolapse treated in the First People's Hospital of Honghe Hani and Yi Autonomous Prefecture from January of 2016 to December of 2017 were randomly divided into the experiment group and control group according to the random number table method with 51 cases in each group.The control group was treated with rectal mucosal ligation while the experiment group was treated with PPH.The perioperative indexes including operative time,pain at 1 day after operation,first defecation time,hospital stay and the efficacy after 12 months of treatment were evaluated in the two groups.The symptoms scores and the anorectal dynamics including anal systolic pressure and resting pressure were compared between the two groups before and after treatment.Results The operative time,pain at 1 day after operation,first defecation time and hospital stay in the experiment group were significantly less than those in the control group(P<0.05).After 12 months of treatment,the marked effective rate of the experiment group was significantly higher than that of the control group(P<0.05).The symptom scores of the two groups were significantly lower after 3 months and 12 months of treatment than before treatment(P<0.05)and those of the experiment group were significantly lower than those of the control group at each time point of treatment(P<0.05).The anal systolic pressure and resting pressure after 3 months of treatment were significantly lower than before treatment in the control group(P<0.05),and there were no significant differences in the anal systolic pressure and resting pressure before and after treatment in the experiment group(P>0.05).Conclusion PPH has good short-term and long-term efficacy and safety in the treatment of ODS caused by rectal mucosal prolapse with clinical application value.