选择性痔上黏膜切除术联合阴道后壁折叠缝合术治疗重度直肠前突的疗效

Curative effect of tissue-selecting therapy stapler combined with posterior vaginal wall folding suture in the treatment of severe rectocele

目的探讨选择性痔上黏膜切除术(TST)联合阴道后壁折叠缝合术治疗重度直肠前突的疗效。方法选取伴有重度直肠前突的出口梗阻型便秘患者80例,随机分为观察组(采用TST联合阴道后壁折叠缝合术)和对照组(采用单纯阴道后壁折叠缝合术),每组40例。比较2组患者的手术时间、术中出血量、住院时间等手术相关指标;于术前和术后1个月行排粪造影检查,比较2组患者直肠前突深度;采用Longo’s出口梗阻型便秘评分评估2组患者术后便秘严重程度;比较2组患者术后便秘症状改善率、复发率以及术后并发症发生率。结果2组患者手术时间、术中出血量及住院时间比较差异均无统计学意义(P>0.05)。2组患者术前直肠前突深度及Longo’s出口梗阻型便秘评分比较差异无统计学意义(P>0.05),术后2组上述指标均较术前显著改善(P<0.05),观察组术后直肠前突深度及Longo’s出口梗阻型便秘评分短/低于对照组(P<0.05)。术后3个月观察组便秘症状改善率显著高于对照组,而复发率显著低于对照组,差异均有统计学意义(P<0.05)。2组患者术后并发症发生率比较差异无统计学意义(P>0.05)。结论TST联合阴道后壁折叠缝合术能纠正出口梗阻型便秘患者的直肠前突形态及排便功能紊乱,短期疗效较好。

Objective To explore the curative effect of tissue-selecting therapy stapler(TST)combined with posterior vaginal wall folding suture in the treatment of severe rectocele.Methods A total of 80 patients with outlet obstructive constipation accompanied by severe rectocele were selected and randomly divided into the observation group(using TST combined with posterior vaginal wall folding suture)and the control group(using simple posterior vaginal wall folding suture),with 40 cases in each group.The operation-related indicators such as operation time,intraoperative bleeding volume,and hospital stay were compared between the two groups.Defecography was performed before surgery and 1 month after surgery to compare the depth of rectocele between the two groups.The Longo’s outlet obstruction constipation score was used to assess the severity of constipation in the two groups.The improvement rate and recurrence rate of constipation symptoms after surgery as well as the incidence of postoperative complications were compared between the two groups.Results There was no statistically significant difference in the operation time,intraoperative bleeding volume or hospital stay between the two groups(P>0.05).There was no statistically significant difference in the preoperative depth of rectocele and Longo’s outlet obstruction constipation score between the two groups(P>0.05),and the above indexes in the two groups were significantly improved after surgery compared with those before surgery(P<0.05).The postoperative depth of rectocele and Longo’s outlet obstruction constipation score in the observation group were significantly shorter/lower than those in the control group(P<0.05).Six months after surgery,the improvement rate of constipation symptoms in the observation group was significantly higher than that in the control group,while the recurrence rate was significantly lower than that in the control group,the differences were statistically significant(P<0.05).There was no statistically significant difference in the incidence of postoperative complications between the two groups(P>0.05).Conclusion TST combined with posterior vaginal wall folding suture can correct the shape of rectocele and defecation dysfunction in patients with outlet obstructive constipation,with good short-term curative effect.