改良直肠黏膜剥除肌层折叠术联合吻合器痔上黏膜环切术治疗完全性直肠脱垂的效果分析

Clinical effect analysis of modified Delorme combined with procedure for prolapse and hemorrhoids in the treatment of complete rectal prolapse

目的分析改良直肠黏膜剥除肌层折叠术(改良Delorme术)联合吻合器痔上黏膜环切术(PPH)治疗完全性直肠脱垂的临床效果。方法选择2017年5月至2020年1月邯郸市第一医院接受手术治疗的94例完全性直肠脱垂患者,按照数字随机法分为联合组和PPH组,各47例,联合组采用改良Delorme术联合PPH治疗,PPH组采用PPH治疗。分析和比较两组患者手术前后肛门功能、直肠肛管功能、并发症、治愈率等临床指标。结果术后1个月,联合组患者治疗有效率明显优于PPH组(100.0%vs 89.4%),差异有统计学意义(Z=-2.901,P=0.004)。两组患者的Wexner便秘评分和Vaizey失禁评分较术前均有所降低,且联合组患者降低程度更明显(P<0.05)。术后90 d,联合组患者直肠感觉阈值显著低于PPH组,肛管功能长度显著高于PPH组,差异有统计学意义(P<0.01)。联合组术后吻合口感染、肛门失禁、黏液便血、小便异常、便秘等总并发症发生率为14.9%,明显低于PPH组的38.3%,差异有统计学意义(χ^(2)=6.594,P<0.05)。结论改良Delorme术联合PPH治疗完全性直肠脱落患者具有治疗有效率高、并发症发生率和复发率低等优势。

Objective To analyze the clinical effect of modified rectum mucosa exfoliation musculotomy(modified Delorme)combined with procedure for prolapse and hemorrhoids(PPH)in the treatment of complete rectal prolapse.Methods From May 2017 to January 2020,94 patients with complete rectal prolapse who received surgical treatment in the First Hospital of Handan City were selected.According to the digital random method,the patients were divided into combination group and PPH group,with 47 patients in each group.The combination group was treated with modified Delorme combined with PPH,while the PPH group was treated with PPH.The following indicators of the two groups were compared including anus function,anorectal function,complications,and cure rate.Results One month after surgery,the effective rate of patients in the combination group was significantly better than that in the PPH group(100.0%vs 89.4%),and the difference was statistically significant(Z=-2.901,P=0.004).The Wexner constipation score and Vaizey incontinence score of patients in both groups were lower than the levels before surgery,and the reduction degree of patients in the combination group was significantly better than that in the PPH group(P<0.05).Ninety days after operation,the rectal sensory threshold of the combination group was significantly lower than that of the PPH group,and the functional length of the anal canal was significantly higher than that of the PPH group,with significant differences between the two groups(P<0.01).The total incidence of complications such as postoperative anastomotic infection,anal incontinence,mucinous stool blood,abnormal urination,constipation in the combination group was 14.9%,significantly lower than 38.3%in the PPH group(χ^(2)=6.594,P<0.05).Conclusion Improved Delorme combined with PPH in the treatment of patients with total rectal abscission has the advantages of higher therapeutic efficiency,lower incidence of complications and lower recurrence rate.