Delorme术联合PPH治疗完全性直肠脱垂的疗效

Delorme operation combined with PPH in the treatment of complete rectal prolapse

目的:探讨直肠黏膜剥除肌层折叠术(Delorme术)与吻合器痔上黏膜环切术(PPH)联合治疗完全性直肠脱垂(RP)的临床疗效。方法:选取60例完全性直肠脱垂住院患者为研究对象,按照手术方式不同分为Delorme术组和Delorme+PPH术组,每组各30例。Delorme术组予以Delorme术治疗;Delorme+PPH组予以Delorme及PPH术治疗。比较两组患者临床疗效、治疗前与术后30 d肛门的直肠压力[最大收缩压(MSP)、最大静息压(MRP)、直肠感觉容量]、术后30 d临床恢复状况[肛门坠胀、控便能力及肛门潮湿评分]、并发症发生率及治疗1年后疾病的复发状况。结果:治疗后,Delorme+PPH术组患者总治愈率高于Delorme术组(96.67%vs.80.00%,P<0.05),MSP及MRP高于Delorme术组(P<0.05),直肠感觉容量低于Delorme术组(P<0.05),临床恢复状况优于Delorme术组(P<0.05),并发症总发生率低于Delorme术组(10.00%vs.43.33%,P<0.05),随访1年后复发率为低于Delorme术组(P<0.05)。结论:Delorme术与PPH术联用治疗完全性RP的临床疗效优于Delorme术,且并发症和复发率更低。

Objective:To investigate the clinical efficacy of rectal mucosal exfoliation and myometrial folding(Delorme)combined with stapler hemorrhoidectomy(PPH)in the treatment of complete rectal prolapse(RP).Methods:60 inpatients with complete rectal prolapse were divided into Delorme operation group and Delorme+PPH group according to different operation methods,30 cases in each group.The Delorme group was treated with Delorme,and the Delorme+PPH group was treated with Delorme and PPH.The curative effects,anal rectal pressure[maximum systolic pressure(MSP),maximum resting pressure(MRP)and rectal sensory volume]before and 30 days after treatment,the clinical recovery status[anal distension,defecation control ability and anal humidity score]30 days after operation,the incidence of complications and the recurrence of the disease 1 year after treatment were compared between the two groups.Results:After treatment,the total cure rate of Delorme+PPH group was significantly higher than that of Delorme group(96.67%vs.80.00%,P<0.05).MSP and MRP in Delorme+PPH group were significantly higher than those in Delorme group(P<0.05).The rectal sensory volume in Delorme+PPH group was significantly lower than that in Delorme group(P<0.05).The clinical recovery of Delorme+PPH group was significantly better than that of Delorme group(P<0.05).The total incidence of complications in Delorme+PPH group was significantly lower than that in Delorme group(10.00%vs.43.33%,P<0.05).After 1 year of follow-up,the recurrence rate in Delorme+PPH group was lower than that in Delorme group(P<0.05).Conclusion:The clinical efficacy of Delorme combined with PPH in the treatment of complete RP is better than Delorme,and the complication and recurrence rate are lower.