目的 比較經(jīng)肛吻合器直腸黏膜環(huán)形切除術(shù)(procedure for prolapse and hemorrhoids,PPH)與經(jīng)直腸閉式修補(bǔ)術(shù)(Block)治療直腸前突的臨床療效。
方法 對2008年9月至2010年9月期間我院手術(shù)治療的62例直腸前突患者的臨床資料進(jìn)行回顧性分析,根據(jù)手術(shù)方式的不同分為PPH組(n=32)和Block組(n=30)。對2組患者手術(shù)后癥狀改善情況進(jìn)行Longo’s 出口梗阻型便秘(ODS)評分,并對手術(shù)時(shí)間、術(shù)中出血量、術(shù)后疼痛評分、需用止痛藥次數(shù)、術(shù)后并發(fā)癥、住院時(shí)間及住院費(fèi)用進(jìn)行比較。
結(jié)果 2組患者術(shù)后排便困難癥狀均有明顯改善。Longo’s ODS評分PPH組術(shù)后1個(gè)月與術(shù)后3個(gè)月比較,差異無統(tǒng)計(jì)學(xué)意義(P>0.05),Block組術(shù)后3個(gè)月明顯高于術(shù)后1個(gè)月(P<0.01)。2組患者術(shù)后1個(gè)月和術(shù)后3個(gè)月Longo’s ODS評分、手術(shù)時(shí)間、術(shù)中出血量、術(shù)后疼痛評分、需用止痛藥次數(shù)及住院時(shí)間方面PPH組均明顯少于Block組(P<0.01);但PPH組的治療費(fèi)用明顯多于Block組(P<0.01)。在PPH組患者中,術(shù)后出現(xiàn)2例輕度肛門失禁,隨訪至術(shù)后3個(gè)月時(shí)完全恢復(fù)。
結(jié)論 PPH治療直腸前突與Block一樣安全、有效,從近期療效上看,優(yōu)于Block手術(shù)且復(fù)發(fā)率較低。
引用本文: 袁鹿,郭劍波,林樹森,李春雨. 經(jīng)肛吻合器直腸黏膜切除術(shù)與經(jīng)直腸閉式修補(bǔ)術(shù)治療直腸前突的對比研究. 中國普外基礎(chǔ)與臨床雜志, 2012, 19(2): 151-156. doi: 復(fù)制
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2. | Dietz H.Rectocele or stool quality:what matters more for symptoms of obstructed defecation?[J].Tech Coloproctol,2009, 13(4):265-268.. |
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4. | Boccasanta P,Venturi M,Stuto A,et al.Stapled transanal rectal resection for outlet obstruction:a prospective,multicenter trial[J].Dis Colon Rectum,2004,47(8):1285-1297.. |
5. | Chen HH,Iroatulam A,Alabaz O,et al.Associations of defecography and physiologic findings in male patients with rectocele[J].Tech Coloproctol,2001,5(3):157-161.. |
6. | Liu J,Zhai LD,Li YS,et al.Measuring the space between vagina and rectum as it relates to rectocele[J].World J Gastroenterol,2009,15(24):3051-3054.. |
7. | Zhang B,Ding JH,Yin SH,et al.Stapled transanal rectal resection for obstructed defecation syndrome associated with rectocele and rectal intussusception[J].World J Gastroenterol,2010, 16(20):2542-2548.. |
8. | Gravié JF,Lehur PA,Huten N,et al.Stapled hemorrhoidopexy versus Milligan-Morgan hemorrhoidectomy:a prospective, randomized,multicenter trial with 2-year ostoperative follow up[J]. Ann Surg,2005,242(1):29-35.. |
9. | Grassi R,Romano S,Micera O,et al.Radiographic findings of post-operative double stapled trans anal rectal resection (STARR) in patient with obstructed defecation syndrome (ODS)[J].Eur J Radiol,2005,53(3):410-416.. |
10. | Zimmernlan CW.Posterior vaginal reconstruction using uterosacral colpopexy:the new posterior repairs[C].Beijing:The first Sino-American meeting of pelvic reconstructive and gynecologic surgeries,2005:196.. |
11. | Satish SR,Kimberly DW,Leistikow JS.Obstructive defecation:a failure of rectoanal coordination[J].Am J Gastroenterol, 1998,93(7):1042-1050.. |
12. | 吳階平,裘法祖.黃家駟外科學(xué)[ M].北京:人民衛(wèi)生出版社, 2000:1188-1189.. |
13. | Mellgren A,Anzén B,Nilsson BY,et al.Results of rectocele repair.A prospective study[J].Dis Colon Rectum,1995, 38(1):7-13.. |
14. | Murthy VK,Orkin BA,Smith LE,et al.Excellent outcome using selective criteria for rectocele repair[J].Dis Colon Rectum, 1996,39(4):374-378.. |
15. | 韓少良,倪士昌.大腸肛門疾病外科治療[ M].北京:人民軍醫(yī)出版社,2006:487-526.. |
16. | 喻德洪.現(xiàn)代肛腸外科學(xué)[ M].北京:人民軍醫(yī)出版社, 1997:477-478.. |
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18. | van Dam JH,Ginai AZ,Gosselink MJ,et al.Role of defecography in predicting clinical outcome of rectocele repair[J].Dis Colon Rectum,1997,40(2):201-207.. |
19. | de Tayrac R,Picone O,Chauveaud-Lambling A,et al.A 2-year anatomical and functional assessment of transvaginal rectocele repair using a polypropylene mesh[J].Int Urogynecol J Pelvic Floor Dysfunct,2006,17(2):100-105.. |
20. | Yamana T,Takahashi T,Iwadare J.Clinical and physiologic outcomes after transvaginal rectocele repair[J].Dis Colon Rectum,2006,49(5):661-667.. |
21. | Schwandner O,Stuto A,Jayne D,et al.Decision-making algorithm for the STARR procedure in obstructed defecation syndrome:position statement of the group of STARR Pioneers[J]. Surg Innov,2008,15(2):105-109.. |
22. | Lenisa L,Schwandner O,Stuto A,et al.STARR with contour transtar:prospective multicentre European study[J].Colorectal Dis,2009,11(8):821-827.. |
23. | Longo A.Treatment of hemorrhoids disease by reduction of mucosa and hemorrhoidal prolapse with a circular stapling device:a new procedure[C].Rome,Italy:Proceedings of the 6th World Congress of Endoscopic Surgery,1998:777-784.. |
24. | Laughlan K,Jayne DG,Jackson D,et al.Stapled haemorrhoidopexy compared to Milligan-Morgan and Ferguson haemorrhoidectomy:a systematic review[J].Int J Colorectal Dis,2009, 24(3):335-344.. |
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26. | Farouk R,Bhardwaj R,Phillips RK.Stapled transanal resection of the rectum (STARR) for the obstructed defaecation syndrome[J].Ann R Coll Surg Engl,2009,91(4):287-291.. |
27. | Regadas FS,Regadas SM,Rodrigues LV,et al.Transanal repair of rectocele and full rectal mucosectomy with one circular stapler:a novel surgical technique[J].Tech Coloproctol,2005, 9(1):63-66.. |
28. | Altomare DF,Rinaldi M,Veglia A,et al.Combined perineal and endorectal repair of rectocele by circular stapler:a novel surgical technique[J].Dis Colon Rectum,2002,45(11):15491552.. |
29. | 梁德森,劉昶,潘尚哈,等.吻合器直腸黏膜環(huán)形切除聯(lián)合經(jīng)直腸閉式修補(bǔ)術(shù)在直腸前突中的應(yīng)用[ J].中華普通外科雜志, 2004,19(9):577-578.. |
30. | Pigot F,Dao-Quang M,Castinel A,et al.Low hemorrhoidopexy staple line does not improve results and increases risk for incontinence[J].Tech Coloproctol,2006,10(4):329-333.. |
31. | Mongardini M,Pappalardo G.The use of Floseal in the prevention and treatment of intra- and post-operative hemorrhage in the surgical treatment of hemorrhoids and colporectocele.Preliminary results[J].G Chir,2003,24(10):377-381.. |
- 1. 尹淑慧,趙克,侯慶香,等.吻合器經(jīng)肛直腸切除術(shù)與經(jīng)陰道手術(shù)治療直腸前突的比較[ J].中國普外基礎(chǔ)與臨床雜志, 2010,17(2):129-132..
- 2. Dietz H.Rectocele or stool quality:what matters more for symptoms of obstructed defecation?[J].Tech Coloproctol,2009, 13(4):265-268..
- 3. Renzi A,Izzo D,Di Sarno G,et al.Stapled transanal rectal resection to treat obstructed defecation caused by rectal intussusception and rectocele[J].Int J Colorectal Dis,2006,21(7):661667..
- 4. Boccasanta P,Venturi M,Stuto A,et al.Stapled transanal rectal resection for outlet obstruction:a prospective,multicenter trial[J].Dis Colon Rectum,2004,47(8):1285-1297..
- 5. Chen HH,Iroatulam A,Alabaz O,et al.Associations of defecography and physiologic findings in male patients with rectocele[J].Tech Coloproctol,2001,5(3):157-161..
- 6. Liu J,Zhai LD,Li YS,et al.Measuring the space between vagina and rectum as it relates to rectocele[J].World J Gastroenterol,2009,15(24):3051-3054..
- 7. Zhang B,Ding JH,Yin SH,et al.Stapled transanal rectal resection for obstructed defecation syndrome associated with rectocele and rectal intussusception[J].World J Gastroenterol,2010, 16(20):2542-2548..
- 8. Gravié JF,Lehur PA,Huten N,et al.Stapled hemorrhoidopexy versus Milligan-Morgan hemorrhoidectomy:a prospective, randomized,multicenter trial with 2-year ostoperative follow up[J]. Ann Surg,2005,242(1):29-35..
- 9. Grassi R,Romano S,Micera O,et al.Radiographic findings of post-operative double stapled trans anal rectal resection (STARR) in patient with obstructed defecation syndrome (ODS)[J].Eur J Radiol,2005,53(3):410-416..
- 10. Zimmernlan CW.Posterior vaginal reconstruction using uterosacral colpopexy:the new posterior repairs[C].Beijing:The first Sino-American meeting of pelvic reconstructive and gynecologic surgeries,2005:196..
- 11. Satish SR,Kimberly DW,Leistikow JS.Obstructive defecation:a failure of rectoanal coordination[J].Am J Gastroenterol, 1998,93(7):1042-1050..
- 12. 吳階平,裘法祖.黃家駟外科學(xué)[ M].北京:人民衛(wèi)生出版社, 2000:1188-1189..
- 13. Mellgren A,Anzén B,Nilsson BY,et al.Results of rectocele repair.A prospective study[J].Dis Colon Rectum,1995, 38(1):7-13..
- 14. Murthy VK,Orkin BA,Smith LE,et al.Excellent outcome using selective criteria for rectocele repair[J].Dis Colon Rectum, 1996,39(4):374-378..
- 15. 韓少良,倪士昌.大腸肛門疾病外科治療[ M].北京:人民軍醫(yī)出版社,2006:487-526..
- 16. 喻德洪.現(xiàn)代肛腸外科學(xué)[ M].北京:人民軍醫(yī)出版社, 1997:477-478..
- 17. Block IR.Transrectal repair of rectocele using obliterative suture[J].Dis Colon Rectum,1986,29(11):707-711..
- 18. van Dam JH,Ginai AZ,Gosselink MJ,et al.Role of defecography in predicting clinical outcome of rectocele repair[J].Dis Colon Rectum,1997,40(2):201-207..
- 19. de Tayrac R,Picone O,Chauveaud-Lambling A,et al.A 2-year anatomical and functional assessment of transvaginal rectocele repair using a polypropylene mesh[J].Int Urogynecol J Pelvic Floor Dysfunct,2006,17(2):100-105..
- 20. Yamana T,Takahashi T,Iwadare J.Clinical and physiologic outcomes after transvaginal rectocele repair[J].Dis Colon Rectum,2006,49(5):661-667..
- 21. Schwandner O,Stuto A,Jayne D,et al.Decision-making algorithm for the STARR procedure in obstructed defecation syndrome:position statement of the group of STARR Pioneers[J]. Surg Innov,2008,15(2):105-109..
- 22. Lenisa L,Schwandner O,Stuto A,et al.STARR with contour transtar:prospective multicentre European study[J].Colorectal Dis,2009,11(8):821-827..
- 23. Longo A.Treatment of hemorrhoids disease by reduction of mucosa and hemorrhoidal prolapse with a circular stapling device:a new procedure[C].Rome,Italy:Proceedings of the 6th World Congress of Endoscopic Surgery,1998:777-784..
- 24. Laughlan K,Jayne DG,Jackson D,et al.Stapled haemorrhoidopexy compared to Milligan-Morgan and Ferguson haemorrhoidectomy:a systematic review[J].Int J Colorectal Dis,2009, 24(3):335-344..
- 25. Burch J,Epstein D,Baba-Akbari A,et al.Stapled haemorrhoidectomy (haemorrhoidopexy) for the treatment of haemorrhoids:a systematic review and economic evaluation[J].Health Technol Assess,2008,12(8):iii-iv,ix-x,1-193..
- 26. Farouk R,Bhardwaj R,Phillips RK.Stapled transanal resection of the rectum (STARR) for the obstructed defaecation syndrome[J].Ann R Coll Surg Engl,2009,91(4):287-291..
- 27. Regadas FS,Regadas SM,Rodrigues LV,et al.Transanal repair of rectocele and full rectal mucosectomy with one circular stapler:a novel surgical technique[J].Tech Coloproctol,2005, 9(1):63-66..
- 28. Altomare DF,Rinaldi M,Veglia A,et al.Combined perineal and endorectal repair of rectocele by circular stapler:a novel surgical technique[J].Dis Colon Rectum,2002,45(11):15491552..
- 29. 梁德森,劉昶,潘尚哈,等.吻合器直腸黏膜環(huán)形切除聯(lián)合經(jīng)直腸閉式修補(bǔ)術(shù)在直腸前突中的應(yīng)用[ J].中華普通外科雜志, 2004,19(9):577-578..
- 30. Pigot F,Dao-Quang M,Castinel A,et al.Low hemorrhoidopexy staple line does not improve results and increases risk for incontinence[J].Tech Coloproctol,2006,10(4):329-333..
- 31. Mongardini M,Pappalardo G.The use of Floseal in the prevention and treatment of intra- and post-operative hemorrhage in the surgical treatment of hemorrhoids and colporectocele.Preliminary results[J].G Chir,2003,24(10):377-381..