Stapled transanal rectal resection for obstructed defecation syndrome associated with rectocele and rectal intussusception

AIM:To evaluate the safety and efficacy of stapled transanal rectal resection(STARR),and to analyze the outcome of the patients 12-mo after the operation.METHODS:From May 2007 to October 2008,50 female patients with rectocele and/or rectal intussusception underwent STARR.The preoperative status,perioperative and postoperative complications at baseline,3,6 and 12-mo were assessed.Data were collected prospectively from standardized questionnaires for the assessment of constipation[constipation scoring system,Longo’s obstructed defecation syndrome(ODS)score system,symptom severity score],patient satisfaction (visual analogue scale),and quality of life(Patient Assessment of Constipation-Quality of Life Questionnaire).RESULTS:At a 12-mo follow-up,significant improvement in the constipation scoring system,ODS score system,symptom severity score,visual analog scale and quality of life(P<0.0001)was observed.The symptoms of constipation improved in 90%of patients at 12 mo after surgery.The self-reported definitive outcome was excellent in 15(30%)patients,fairly good in 8(16%),good in 22(44%),and poor in 5(10%).CONCLUSION:STARR can be performed safely without major morbidity.Moreover,the procedure seems to be effective for patients with obstructed defecation associated with symptomatic rectocele and rectal intussusception.

Khubchandani's procedure combined with stapled posterior rectal wall resection for rectocele

BACKGROUND Obstructed defecation syndrome(ODS) is a widespread disease in the world.Rectocele is the most common cause of ODS in females. Multiple procedures have been performed to treat rectocele and no procedure has been accepted as the gold-standard procedure. Stapled transanal rectal resection(STARR) has been widely used. However, there are still some disadvantages in this procedure and its effectiveness in anterior wall repair is doubtful. Therefore, new procedures are expected to further improve the treatment of rectocele.AIM To evaluate the efficacy and safety of a novel rectocele repair combining Khubchandani's procedure with stapled posterior rectal wall resection.METHODS A cohort of 93 patients were recruited in our randomized clinical trial and were divided into two different groups in a randomized manner. Forty-two patients(group A) underwent Khubchandani's procedure with stapled posterior rectal wall resection and 51 patients(group B) underwent the STARR procedure.Follow-up was performed at 1, 3, 6, and 12 mo after the operation. Preoperative and postoperative ODS scores and depth of rectocele, postoperative complications, blood loss, and hospital stay of each patient were documented. All data were analyzed statistically to evaluate the efficiency and safety of our procedure.RESULTS In group A, 42 patients underwent Khubchandani's procedure with stapled posterior rectal wall resection and 34 were followed until the final analysis. In group B, 51 patients underwent the STARR procedure and 37 were followed until the final analysis. Mean operative duration was 41.47 ± 6.43 min(group A) vs39.24 ± 6.53 min(group B). Mean hospital stay was 3.15 ± 0.70 d(group A) vs 3.14± 0.54 d(group B). Mean blood loss was 10.91 ± 2.52 mL(group A) vs 10.14 ± 1.86 m L(group B). Mean ODS score in group A declined from 16.50 ± 2.06 before operation to 5.06 ± 1.07 one year after the operation, whereas in group B it was17.11 ± 2.57 before operation and 6.03 ± 2.63 one year after the operation. Mean depth of rectocele decreased from 4.32 ± 0.96 cm(group A) vs 4.18 ± 0.95 cm(group B) preoperatively to 1.19 ± 0.43 cm(group A) vs 1.54 ± 0.82 cm(group B)one year after operation. No other serious complications, such as rectovaginal fistula, perianal sepsis, or deaths, were recorded. After 12 mo of follow-up, 30 patients'(30/34, 88.2%) final outcomes were judged as effective and 4(4/34,11.8%) as moderate in group A, whereas in group B, 30(30/37, 81.1%) patients' outcomes were judged as effective, 5(5/37, 13.5%) as moderate, and 2(2/37,5.4%) as poor.CONCLUSION Khubchandani's procedure combined with stapled posterior rectal wall resection is an effective, feasible, and safe procedure with minor trauma to rectocele.

Measuring the space between vagina and rectum as it relates to rectocele

AIM:To measure the normal space between the posterior wall of the vagina and the anterior wall of the respectively rectum using computed tomography(CT) and reveal its were relationship to rectocele. METHODS:A total of twenty female volunteers without rectocele were examined by CT scan.We performed a middle level continuous horizontal pelvic scan from the upper part to the lower part and collected the measurement data to analyze the results using t-test. RESULTS:Twenty volunteers were enrolled in the study. The space between the posterior wall of the vagina and the anterior wall of the rectum was measured at three levels(upper 1/3,middle,lower 1/3 level of vagina). The results showed that the space from the posterior wall of the vagina to the anterior wall of the rectum at the upper 1/3 level and the middle level was 3.896 ±0.3617 mm and 4.6575±0.3052 mm,respectively. When the two groups of data were compared,we found the space at the upper 1/3 level was shorter than at the middle level(P<0.01).Moreover,at the lower 1/3 level the space measured was 10.058±0.4534 mm.The results revealed that the space at the lower 1/3 level was longer than that at the middle level(P<0.01). CONCLUSION:These measurement data may be helpful in assessing rectocele clinical diagnosis and functional outcomes of rectocele repair.

Therapeutic effects of the TST36 stapler on rectocele combined with internal rectal prolapse

BACKGROUND The most common causes of outlet obstructive constipation(OOC)are rectocele and internal rectal prolapse.The surgical methods for OOC are diverse and difficult,and the postoperative complications and recurrence rate are high,which results in both physical and mental pain in patients.With the continuous deepening of the surgeon’s concept of minimally invasive surgery and continuous in-depth research on the mechanism of OOC,the treatment concepts and surgical methods are continuously improved.AIM To determine the efficacy of the TST36 stapler in the treatment of rectocele combined with internal rectal prolapse.METHODS From January 2017 to July 2019,49 female patients with rectocele and internal rectal prolapse who met the inclusion criteria were selected for treatment using the TST36 stapler.RESULTS Forty-five patients were cured,4 patients improved,and the cure rate was 92%.The postoperative obstructed defecation syndrome score,the defecation frequency score,time/straining intensity,and sensation of incomplete evacuation were significantly decreased compared with these parameters before treatment,and the differences were statistically significant(P<0.05).The postoperative anal canal resting pressure and maximum squeeze pressure in patients decreased compared with before treatment,and the differences were statistically significant(P<0.05).The initial and maximum defecation thresholds after surgery were significantly lower than those before treatment,and the differences were statistically significant(P<0.05).The postoperative ratings of rectocele,resting phase,and defecation phase in these patients were significantly decreased compared with those before treatment,and the differences were statistically significant(P<0.05).CONCLUSION The TST36 stapler is safe and effective in treating rectocele combined with internal rectal prolapse and is worth promoting in clinical work.

Literature review of the outcome of and methods used to improve transperineal repair of rectocele

BACKGROUND Rectocele is commonly seen in parous women and sometimes associated with symptoms of obstructed defecation syndrome(ODS).AIM To assess the current literature in regard to the outcome of the classical transperineal repair(TPR)of rectocele and its technical modifications.METHODS An organized literature search for studies that assessed the outcome of TPR of rectocele was performed.PubMed/Medline and Google Scholar were queried in the period of January 1991 through December 2020.The main outcome measures were improvement in ODS symptoms,improvement in sexual functions and continence,changes in manometric parameters,and quality of life.RESULTS After screening of 306 studies,24 articles were found eligible for inclusion to the review.Nine studies(301 patients)assessed the classical TPR of rectocele.The median rate of postoperative improvement in ODS symptoms was 72.7%(range,45.8%-83.3%)and reduction in rectocele size ranged from 41.4%-95.0%.Modifications of the classical repair entailed omission of levatorplasty,addition of implant,concomitant lateral internal sphincterotomy,changing the direction of plication of rectovaginal septum,and site-specific repair.CONCLUSION The transperineal repair of rectocele is associated with satisfactory,yet variable,improvement in ODS symptoms with parallel increase in quality-of-life score.Several modifications of the classical TPR were described.These modifications include omission of levatorplasty,insertion of implants,performing lateral sphincterotomy,changing the direction of classical plication,and site-specific repair.The indications for these modifications are not yet fully clear and need further prospective studies to help tailor the technique to rectocele patients.

Significance of defecography and the role of rectocele in constipated patients

Backround: Chronic constipation is a common, chronic and frequent problem of the general population. The aim of this study is to assess the efficacy of defecography in diagnosing the etiology of constipation and the relation between constipation and rectocele. Material-method: We have investigated 250 patients who have been admitted to our general surgery out-patient clinic with complaint of constipation using Rome III criteria and diagnostic defecography. Results: Out of 250 patients who were evaluated with defecography only 24 had normal findings. 136 patients were found to have rectocele. Conclusion: We propose that rectocele is an important etiology of constipation, and defecography should be considered early in the diagnosis of rectocele.

Bloodless Outpatient Surgical Treatment of Rectocele and Cystocele under Local Anesthesia

Background: Surgical treatment of rectocele and cystocele is usually performed in a hospital setting under regional (spinal or epidural) or general anesthesia, and patients commonly have to stay in the hospital for at least one or two days. The possibility of performing the surgery under local anesthesia, as an outpatient procedure with minimal bleeding and pain, no surgical assistants, with immediate discharge and, most importantly, without compromising postoperative results, is appealing. To our knowledge, no studies have evaluated whether performing rectocele and/or cystocele rectocele repair under local infiltration anesthesia and without separation of the vaginal mucosa from the underlying fascia achieves these goals. Objective: The aim of this study is to describe a new surgical technique for outpatient treatment of cystocele and rectocele under local anesthesia, and our initial results. Materials and Methods: Forty women underwent outpatient surgical repair of rectocele and/or cystocele between April and September 2020 at the ambulatory procedure room of the authors’ clinics. The technique consists of a triangular-shaped CO2 laser vaporization or electrocauterization of the posterior and/or anterior vaginal epithelium, followed by plication of the edges of the triangle with 0 polygalactin suture. A perineorrhaphy was always performed concomitantly with rectocele repair, and a transobturator sling was performed in women presenting with concomitant stress urinary incontinence. Postoperative evaluation included POP-Q measurement for each patient six months after the procedure, and resolution of prolapse was considered when anterior and/or posterior vaginal wall presented as stage 0 or 1. Pre and postoperative POP-Q measurements were analyzed using Wilcoxon signed-rank test. Results: The mean operating time was 21 minutes (range: 14 - 38 minutes). All patients tolerated the procedure well and were discharged immediately afterwards. There were no intraoperative or postoperative complications, and all patients had satisfactory healing of the vaginal mucosa. Bleeding from the rectocele and/or cystocele repair was minimal, and nobody required extra-anesthesia or transfer to a hospital surgical theater. At six month follow-up, pre and postoperative POP-Q measurements of points Ap, Bp, Aa and Ba were all statistically significant (Ap 1.6 ± 1.2 × -2.4 ± 0.9, Bp 2.6 ± 1.6 × -2.7 ± 1.4, Aa 1.4 ± 1.1 × -2.3 ± 0.8, and Ba 2.4 ± 1.5 × -2.5 ± 1.2) respectively, revealing satisfactory resolution of both rectocele and cystocele. Conclusion: Our initial results suggest that rectocele and cystocele may be safely and effectively treated under local anesthesia in an outpatient setting using this new technique.

重度直肠前突患者肛管直肠动力学分析

目的评估重度直肠前突患者肛管直肠动力学结果。方法回顾性分析2020年1月—2023年1月南京市中医院肛肠科盆底中心明确诊断为重度直肠前突的38例患者的临床资料,对所有患者均行肛管直肠压力测定,对肛管直肠动力学结果进行分析。结果肛管静息压升高15例(39.47%),正常20例(52.63%),降低3例(7.89%);肛管最大收缩压升高5例(13.16%),正常9例(23.68%),降低24例(63.16%);排便弛缓反射正常15例(39.47%),异常23例(60.53%);直肠排便压正常10例(26.32%),下降28例(73.68%);直肠初始阈值升高11例(28.95%),正常27例(71.05%);直肠排便感觉阈值升高15例(39.47%),正常21例(55.26%),降低2例(5.26%);直肠最大耐受量升高3例(7.89%),正常26例(68.42%),降低9例(23.68%)。肛管静息压与慢性便秘严重程度量表(CSS)评分呈中度正相关(P=0.007,r=0.429),排便弛缓反射异常与CSS评分呈中度负相关(P=0.019,r=-0.329)。肛管静息压和肛管最大收缩压均降低3例(7.89%);肛管静息压和肛管最大收缩压均升高5例(13.16%)。结论重度直肠前突患者术前需要进行肛管直肠动力学分析,以制订合理的个体化手术及术后康复方案。

改良经阴道后壁切开直肠前突修补术对直肠前突患者的疗效

目的分析改良经阴道后壁切开直肠前突修补术(MTVRR)对中重度直肠前突(RC)患者的疗效。方法回顾性分析行MTVRR治疗的21例女性RC患者的临床资料。术前及术后3、6、12、24个月,采用便秘评分系统(CSS)量表评估患者的便秘症状,记录患者症状改善有效率。观察RC患者术后并发症发生情况。结果21例患者顺利完成手术,手术时间为25~135 min,平均为(83.14±30.39)min;住院时间为10~21 d,平均为(14.10±2.34)d。术后,21例患者中,1例患者失访。20例患者术后CSS量表评分低于术前,差异有统计学意义(P<0.05)。20例患者术后3、6、12个月的便秘症状改善总有效率分别为100.00%、90.00%、80.00%。20例患者中,15例患者完成术后24个月的随访,其术后CSS量表评分低于术前,差异有统计学意义(P<0.05)。15例患者术后24个月便秘症状改善总有效率为80.00%。术后随访显示,无1例患者出现并发症。结论MTVRR可改善中重度RC患者的便秘症状,且疗效较好。

Is the transperineal ultrasonography approach effective for the diagnosis of rectocele?

Background Transperineal ultrasonography has been used as a diagnostic imaging modality for rectocele for many years.However,the consistency of ultrasonography and defecography in evaluating the severity of rectocele was not satisfactory.This study aimed to evaluate the agreement in the measurement of rectocele parameters between the two methods in different positions and provide clinical implications for the diagnosis of rectocele.Methods In this pilot study,participants were recruited in an outpatient clinic of a tertiary hospital between December 2017 and December 2019.All participants separately underwent defecation proctography at sitting and squatting positions,and undertook transperineal ultrasonography at left lateral,sitting,and squatting positions.The consistency of ultrasonography and defecography was evaluated.Results Thirty female volunteers with rectocele were included in this study.The degree of anorectal angle was significantly larger at rest and during contraction,maximal Valsalva,and evacuation;the depth of the rectocele was significantly deeper during maximal Valsalva and evacuation;and the length of the perineumdescending was significantly longer during contraction and maximal Valsalva in using squatting position compared to the sitting position when performing the defecation proctography.The degree of anorectal angle,the depth of rectocele,the area of levator hiatus,and the volume of the rectocele were significantly different in using squatting,sitting,and left lateral positions when performing the transperineal ultrasonography.Bland-Altman semi-quantitative plots showed good consistency in the measurement of the anorectal angle and the depth of the rectocele between proctography and ultrasonography in both sitting and squatting positions.Conclusions The findings of our study may be considered as the preliminary evidence to support the use of transperineal ultrasonography with sitting and squatting positions as the imaging test of choice for evaluating patients with rectocele.

Outcomes of a modified Bresler procedure for the treatment of rectocele with rectal intussusception

Background:Obstructed defecation syndrome(ODS)is a condition that is frequently caused by rectocele and rectal intussusception.This study aimed to evaluate the effectiveness of a modified Bresler procedure for the treatment of ODS.The outcomes of this modified procedure were compared with the stapled transanal rectal resection(STARR)procedure.Methods:We performed a retrospective analysis of the clinical data from 76 female patients who presented with ODS between June 2014 and June 2016.The patients were divided into two treatment groups,namely Modified and STARR.Patients in the Modified group(n=36)underwent the modified Bresler procedure,which involved posterior rectal-wall resection using a circular tubular stapler with multilevel purse-string sutures.Patients in the STARR group(n=40)underwent the standard STARR procedure.We analysed post-operative complications,Wexner constipation scores(WCS),rectocele depths,and four-point post-operative satisfaction scales.Results:Patients in the Modified group exhibited shorter operative times and fewer post-operative complications(both P<0.05).At 12 months post-operatively,both the Modified and STARR groups displayed a significant improvement in the Wexner constipation score and the depth of rectocele.The post-operative WCS for the Modified group were significantly improved compared to those for the STARR group(P<0.05),while there was no significant difference in the rectocele depth between the two groups(P>0.05).Post-operative interviews at post-operative 12 months showed that patients in the Modified group had a better satisfaction(P=0.05).Conclusions:Our modified procedure may be an effective treatment strategy for patients experiencing ODS caused by rectocele and rectal intussusception,with fewer complications and effective relief of symptoms.

盆底四维超声量化评估后盆腔异常在女性出口梗阻型便秘诊断中的价值

目的 探讨盆底四维超声测量肛直角(ARA)大小及肛提肌裂孔面积(LH)量化评估后盆腔异常在女性出口梗阻型便秘(OOC)诊断中的应用价值。方法 前瞻性选取宝鸡市中心医院消化内科及肛肠外科因便秘就诊,盆底四维超声诊断为后盆腔异常且符合出口梗阻型便秘的女性患者142例为研究组,68名健康体检者为对照组,应用盆底四维超声在静息状态和Vasvala状态下分别测量ARA大小;观察直肠壶腹在静息状态及Vasvala状态的位置变化;并在Vasvala状态测量最大LH面积,将2组的测量数据进行对比分析。结果 静息状态时研究组中ARA大小为(116±10)°,对照组ARA大小为(107±11)°,差异有统计学意义(t=5.37,P<0.05)。Valsalva动作时,研究组ARA大小为(107±10)°,较静息状态变小;对照组ARA大小为(119±11)°,较静息状态增大,差异有统计学意义(t=-7.92,P<0.05);Valsalva动作时研究组最大LH面积为(31.5±6.1)cm^(2),对照组为(20.0±2.4)cm^(2),研究组大于对照组,2组比较差异无统计学意义(t=18.97,P<0.05)。研究组分型中,静息状态下直肠前突者ARA大小为(116±10)°,会阴体过度运动者ARA大小为(116±10)°,2组比较差异无统计学意义(t=-0.034,P>0.05);Valsalva动作下直肠前突者ARA大小为(105±11)°,较静息状态减小;会阴体过度运动者ARA大小为(108±9)°,较静息状态减小。Valsalva动作下直肠前突者的ARA略小于会阴体过度运动者,二者差异有统计学意义(t=-1.32,P<0.10);Valsalva动作下直肠前突者LH最大面积(32.4±6.2)cm^(2),会阴体过度运动者LH最大面积(30.7±5.8)cm^(2),Valsalva动作下直肠前突者的LH最大面积略大于会阴体过度运动者,二者差异有统计学意义(t=1.63,P<0.10)。结论 盆底四维超声通过测量ARA大小、Valsalva状态LH最大面积量化评估后盆腔异常在诊断女性OOC与其具体分型中有一定的参考价值。

补气养阴通便汤配合多点柱状缝扎术治疗直肠前突临床观察

目的:观察补气养阴通便汤配合多点柱状缝扎术治疗直肠前突的临床疗效。方法:选取符合纳入标准的直肠前突住院患者50例作为研究对象,按随机数字表法分为对照组和观察组各25例。对照组采取多点柱状缝扎术治疗,观察组在对照组的基础上给予补气养阴通便汤治疗。比较两组术后疼痛评分、便秘患者症状自评量表评分、临床疗效、术后并发症发生情况。结果:对照组术后24、48、72 h疼痛评分高于观察组(P<0.05)。对照组治疗后便秘患者症状自评量表总分高于观察组(P<0.05)。总有效率观察组为96.00%(24/25),高于对照组的76.00%(19/25)(P<0.05)。术后并发症发生率对照组为16.00%(4/25)高于观察组的4.00%(1/25),但差异无统计学意义(P>0.05)。结论:补气养阴通便汤配合多点柱状缝扎术,可有效降低直肠前突患者术后痛感、减轻便秘程度,提高临床疗效。

基于SERVQUAL模型的护理在直肠前突患者中的应用效果

目的:观察基于SERVQUAL模型的护理在直肠前突患者中的应用效果。方法:选取2020年10月至2022年6月该院收治的82例直肠前突患者进行前瞻性研究,按随机数字表法将其分为对照组与观察组各41例。对照组采取常规护理,观察组在对照组基础上采取基于SERVQUAL模型的护理,比较两组围术期相关指标水平、疼痛程度[视觉模拟评分法(VAS)]评分、负性情绪[抑郁自评量表(SDS)、焦虑自评量表(SAS)]评分、舒适度[简化舒适状况量表(GCQ)]评分、并发症发生率和护理满意度。结果:观察组术后首次排便时间、单次排便所用时间、住院时间均短于对照组,差异有统计学意义(P<0.05);术后1、3 d,观察组VAS评分均低于对照组,差异有统计学意义(P<0.05);护理后,两组SDS、SAS评分均低于护理前,且观察组低于对照组,差异有统计学意义(P<0.05);护理后,两组生理、心理、社会文化、环境等GCQ评分均高于护理前,且观察组高于对照组,差异有统计学意义(P<0.05);观察组并发症发生率低于对照组,护理满意度高于对照组,差异均有统计学意义(P<0.05)。结论:在常规护理基础上采用基于SERVQUAL模型的护理可提高直肠前突患者舒适度评分和护理满意度,改善围术期相关指标水平,降低VAS评分、负性情绪评分和并发症发生率,其效果优于单纯常规护理。

火针“扶阳调气法”治疗直肠前突术后慢传输型便秘的验案举隅

火针“扶阳调气法”是山西省针灸医院针灸三科一项常用的新九针特色技术疗法,临床常用于治疗胃肠病,尤其对慢传输型便秘(STC)具有独特的疗效。近年来,通过尝试将其应用于治疗直肠前突术后STC,临床疗效显著。本研究主要从STC的病因病机、火针“扶阳调气法”的操作规范、技术内涵、特色优势等方面出发,拟通过治疗重度直肠前突术后STC的临床验案,详细分析其诊疗思路及过程,探讨其作用机理,通过定期追踪随访,证实本疗法能够温阳益气、调畅气机、导滞通腑,且无毒副作用,不仅对常见的STC有效,而且对直肠前突术后的STC亦有很好的临床疗效,值得临床推广应用,为针灸治疗直肠前突术后的STC,提供新的思路和依据。

直肠前突型便秘的手术新进展及预后相关因素分析

目的:探讨直肠前突型便秘的术式新进展及影响手术疗效的相关因素。方法:采取文献回顾法,对目前国内、外关于直肠前突型便秘的手术方式及预后因素进行分析和综述。结果:直肠前突型便秘的手术方式从入路大致可分为四大类:经直肠、经阴道、经会阴、经腹。就现有的文献报导上述四类手术方式的术后疗效无显著差异;而手法协助排便史、排粪造影中直肠前突内钡剂储留程度、直肠前突的大小、合并结肠慢传输及其它出口梗阻因素、一些全身性疾病等对直肠前突便秘的术后疗效均有影响。结论:便秘是一个多因素致病的结果(直肠前突仅为其中原因之一)。由于目前对便秘的病因病理等基础研究还不充分,因此临床上要注意判断直肠前突与便秘的关系,掌握好手术指征,并尽可能选择对患者损伤小、痛苦少的手术为宜。

实时三维超声鉴别诊断阴道后壁膨出病变

目的探讨经会阴实时三维超声鉴别诊断阴道后壁膨出病变的价值。方法对91例临床确诊为阴道后壁膨出的患者应用经会阴实时三维超声进行检查,评价图像质量,并分析其声像图特点。结果 91例患者均能配合并完成检查。图像质量评分均为3分。超声诊断直肠膨出38例,会阴体过度运动48例,肠疝5例。直肠膨出及会阴体过度运动均表现为直肠壶腹部不同程度下移至参考线以下,但只有前者膨出物突向阴道内;肠疝表现为疝出物位于直肠壶腹部与阴道间。结论经会阴实时三维超声可用于阴道后壁膨出病变的鉴别诊断,可为临床治疗提供更多有价值的信息。

吻合器行痔上黏膜环切术加直肠前壁柱状缝合治疗女性直肠前突引起的出口梗阻型便秘的疗效观察

目的探讨应用痔吻合器行痔上黏膜切除术(PPH)治疗因直肠前突引起的出口梗阻型便秘的临床效果。方法利用该手术治疗42例女性直肠前突患者,对其治疗效果进行分析。结果治愈27例,症状明显好转11例,症状缓解不佳4例。术前、术后1个月、术后3个月时的症状评分分别为:(16±2)分、(6±1)分、(5±1)分,差别有统计学意义(F=861.74,P<0.05)。结论PPH治疗直肠前突引起的出口梗阻型便秘疗效显著,并发症少,恢复快,近期效果较好。

直肠前突与出口梗阻性便秘的关系

目的探讨直肠前突与功能性出口梗阻性便秘的关系及临床意义。方法回顾性分析417例功能性出口梗阻性便秘患者的临床和动态排粪造影资料。对直肠前突病例的力排过程进行动态回放,并分析其表现。结果①310例有直肠前突,392例有直肠内脱垂,353例有会阴下降,69例有盆底痉挛或耻直肌肥厚。95.20%(397/417)的病例至少存在两种异常,无单发直肠前突病例。男女患者间比较,直肠前突、会阴下降、盆底痉挛或耻直肌肥厚的发生率差异均有统计学意义(P<0.01),但直肠内脱垂的发生率差异无统计学意义(P>0.05)。②直肠前突病例力排过程动态回放:直肠内钡剂排空或接近排空、直肠远端增粗粘膜堆积226例,占72.90%;直肠内钡剂不排或呈滴状排出、远端粘膜脱入肛管和(或)盆底痉挛或耻直肌肥厚71例,占22.90%;前突囊袋缩小不明显、囊袋后方直肠内脱垂13例,占4.20%。结论直肠前突不是引起便秘的主要原因,明确直肠前突与功能性出口梗阻性便秘的关系对临床制定治疗方案有指导意义。

益气养阴法联合STARR手术治疗直肠前突的临床疗效观察

目的观察益气养阴法联合经肛门吻合器直肠部分切除术(STARR)治疗直肠前突的临床疗效。方法选择符合纳入标准的直肠前突患者160例,随机分为治疗组和对照组,各80例。对照组患者单纯给予STARR术治疗,治疗组给予STARR术联合益气养阴法方药(补中益气汤联合大补阴丸加减)治疗。治疗33 d后观Longo's出口梗阻型便秘评分(Longo ODS)、中医症候评分及排粪造影情况。结果两组患者治疗后Longo ODS评分、中医症候评分及排粪造影情况均优于本组治疗前(P<0.05),且治疗组治疗后各指标改善情况明显优与对照组,两组比较差异有统计学意义(P<0.05)。结论益气养阴法联合STARR术治疗直肠前突疗效优于单纯STARR术,两者联合可以明显提高发病直肠前突临床症状,值得进一步推广研究。