超声引导下小针刀钩切治疗耻骨直肠肌综合征临床观察

Clinical Observation on Acupotomology Excision in the Treatment of Puborectalis Syndrome under Ultrasound Guidance

目的探寻超声引导下小针刀钩切治疗耻骨直肠肌综合征(PRS)的临床效果。方法根据耻骨直肠肌综合征患者导致出口梗阻性便秘(ODS)机理及耻骨直肠肌解剖结构,选取60例诊断明确的耻骨直肠肌综合征患者,在骶管麻醉状态下,肛管直肠腔内超声清晰显示耻骨直肠肌解剖结构,在其引导下,小针刀钩切耻骨直肠肌(PRM)约1.5~2.0 cm,并观察疗效。结果60例患者在治疗前后比较,便秘症状评分均降低,排便总满意度均提高,差异具有统计学意义(P<0.05);肛肠动力学各项目指标均明显得到改善,治疗前后比较差异具有统计学意义(P<0.05);患者治愈43例(71.7%),有效17例(28.3%),无效0例,总有效率为100%,所有患者随访1年,其中3个月内PRS复发3例(5.0%),6个月内PRS复发5例(8.3%),1年内PRS复发8例(13.3%)。结论肛管直肠腔内超声清晰显示耻骨直肠肌结构及周围组织关系,在其引导下,小针刀钩切耻骨直肠肌,准确、不良损伤小、并发症及后遗症少、易操作等优点,值得临床上进一步研究。

Objective To explore the clinical effect of acupotomology excision in the treatment of puborectalis syndrome under ultrasound guidance.Methods According to puborectalis muscle(PRM)anatomy and factors of puborectalis syndrome(PRS)causing obstructed defecation syndrome(ODS),retrospectively review 60 cases of PRS who had experienced partly excision of PRM with acupotomology in sacral canal anesthesia under the guidance of ultrasound was carried out.Results The scores of constipation symptoms and total satisfaction with defecation of the 60 patients were all decreased before and after treatment,and the difference was statistically significant(P<0.05).All indexes of anorectal dynamics were significantly improved,and the difference before and after treatment was statistically significant(P<0.05).Patients cured 43 cases(71.7%),effective 17 cases(28.3%),ineffective 0 cases,the total effective rate was 100%,all patients were followed up for 1 year,among which PRS recurrence 3 cases(5.0%)within 3 months,PRS recurrence 5 cases(8.3%)within 6 months,PRS recurrence 8 cases(13.3%)within 1 year.Conclusion Excision of PRM is accurate and simple by acupotomology with the assistant of ultrasound which clearly show PRM anatomy,which deserve a further study.