立体四重术式治疗Ⅲ度直肠脱垂的临床疗效观察

Clinical efficacy of an operation encompassing quadruple procedures for the treat⁃ment of gradeⅢrectal prolapse

目的分析立体四重术式治疗Ⅲ度直肠脱垂的临床疗效。方法回顾性分析2015年1月至2020年12月于河北中医学院第一附属医院肛肠科行立体四重术式治疗的40例Ⅲ度直肠脱垂患者的临床资料。分析手术相关指标,手术前后肛门功能(Wexner便秘评分和Wexner肛门失禁评分),手术前后盆腔MRI测量指标(肛上距、肛直角和骶直距),术后并发症发生情况及临床疗效。结果40例患者手术时间为81~105 min,平均手术时间(92.0±6.6)min;术中出血量为21~64 mL,术中平均出血量(40.8±13.6)mL;术中切除黏膜长度为4.8~6.3 cm,切除黏膜平均长度(5.6±0.4)cm;住院时间为10~18 d,平均住院时间(13.6±2.3)d。术后Wexner便秘评分和Wexner肛门失禁评分均较术前改善,差异均有统计学意义(均P<0.05)。患者术后静息状态下的肛上距小于术前,肛直角大于术前,骶直距小于术前,差异均有统计学意义(均P<0.05)。有3例患者于术后出现轻、中度肛门疼痛,1例患者出现吸收热(<37.6℃),4例患者出现术后排尿困难,其余32例患者均未诉特殊不适。术后随访半年无复发病例,其中治愈39例(97.5%)、有效1例(2.5%)。结论采用立体四重术式治疗Ⅲ度直肠脱垂具有良好的临床疗效,对患者肛门功能也有改善作用。

Objectives To analyze the clinical efficacy of an operation encompassing quadruple procedures for the treatment of gradeⅢrectal prolapse.Methods This was a retrospective analysis of 40 patients with gradeⅢrectal prolapse treated with an operation encompassing quadruple procedures at the Department of Colorectal Surgery,The First Affiliated Hospital of Hebei Uni⁃versity of Traditional Chinese Medicine,between January 2015 and December 2020.Surgical parameters,anal function before and after surgery(Wexner constipation score and Wexner anal incontinence score),pelvic MRI measurements before and after surgery[distance between the upper part of anal canal(DUAC)and pubococcygeal line,anorectal angle(ARA),and distance between the sacrum and rectum(DSR)],postoperative complications and clinical efficacy were analyzed.Results The operation time of 40 patients ranged from 81 min to 105 min,and the average operation time was(92.0±6.6)min.Intraoperative blood loss ranged from 21 mL to 64 mL,with an average of(40.8±13.6)mL.The resection mucosa length was 4.8~6.3 cm,with an average length of(5.6±0.4)cm.The length of hospital stay was 10~18 days,and the average length was(13.6±2.3)days.Wexner constipation score and Wexner anal incontinence score were significantly lower than those before surgery(P<0.05).After surgery,resting dis⁃tance between DUAC and pubococcygeal line and DSR decreased significantly,while ARA increased significantly(P<0.05).There were 3 patients with mild and moderate anal pain after surgery,1 patient with absorption fever(<37.6℃),4 patients with postoperative dysuria,and the other 32 patients did not have special discomfort.There was no recurrence during half a year fol⁃low-up,among which 39 cases(97.5%)were cured,and 1 case(2.5%)was effective.Conclusion The treatment of gradeⅢrectal prolapse with an operation encompassing quadruple procedures has good clinical efficacy and can improve the anal func⁃tion of patients.