中国普外基础与临床杂志

中国普外基础与临床杂志

吻合器痔上黏膜环形切除术联合直肠闭式修补术治疗出口梗阻型便秘的中远期疗效比较

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目的 探讨吻合器痔上黏膜环形切除术(PPH)联合直肠闭式修补术(Block 术)治疗直肠前突(RE)导致的出口梗阻型便秘(ODS)的中远期疗效。 方法 回顾性分析 2011 年 3 月至 2013 年 5 月期间于辽宁省朝阳市中心医院行 PPH+Block 术(PPH+Block 组)或单纯 PPH(PPH 组)的 187 例由 RE 导致的 ODS 患者的临床资料,其中 PPH+Block 组 95 例,PPH 组 92 例。比较 2 组患者术后的 Longo’s ODS 评分、疗效、手术效果及复发率。 结果 ① 术后的 Longo’s ODS 评分:术后 1 年和术后 3 年时,PPH+Block 组和 PPH 组患者的 ODS 评分比较差异均有统计学意义(P<0.05),PPH 组均较高。② 疗效:PPH+Block 组和 PPH 组患者的总有效率均为 100%,但 PPH+Block 组的具体疗效较 PPH 组优(Z=–10.15,P<0.05)。③ 手术效果:2 组患者的手术时间、术中出血量、恢复正常活动时间、住院时间及术后视觉模拟疼痛评分(VAS)比较差异均无统计学意义(P>0.05),2 组患者的尿潴留发生率、便血发生率、排气性肛门失禁发生率及肛裂发生率比较差异也均无统计学意义(P>0.05),但 PPH+Block 组的便急感或肛门下坠感发生率较 PPH 组高(P<0.05)。④ 中远期复发率:2 组患者的术后 1 年复发率比较差异无统计学意义(P>0.05),但 PPH 组的术后 3 年复发率高于 PPH+Block 组,差异有统计学意义(P<0.05)。 结论 PPH 联合 Block 术治疗 RE 导致的 ODS 的中期治疗效果与单纯 PPH 无明显差异,但前者的远期复发率较后者低,中长期效果稳定。

Objective To explore the medium- and long-term clinical effects of procedure for prolapse and hemorrhoids (PPH) combined with Block operation for obstructed defecation syndrome (ODS). Methods Clinical data of 187 patients with ODS caused by rectocele (RE) who received PPH+Block operation or pure PPH operation in The Chaoyang City Central Hospital from Mar. 2011 to May. 2013, were collected retrospectively, in which 95 patients underwent PPH+Block operation (PPH+Block group) and 92 patients underwent PPH operation (PPH group). Compared the postoperative Longo’s score, postoperative clinical effect, operative effect, and recurrence rate between the 2 groups. Results ① The postoperative Longo’s score: the postoperative Longo’s scores of the PPH+Block group were both lower than those of the PPH group at 1- and 3-year after operation (P<0.05). ② Postoperative curative effect: the total effective rate of the PPH+Block group and the PPH group were both 100%, but the clinical effect of the the PPH+Block group was better than that of the PPH group (Z=–10.15, P<0.05). ③ Operative effect: there was no statistical significance on operative time, intraoperative blood loss, returned to normal activity time, hospital stay, and postoperative visual analogy score (VAS) between the 2 groups (P>0.05). In addition, there were no statistical significance on the incidences of urinary retention, hematochezia, exhaust anal incontinence, and anal fissure between the 2 groups (P>0.05), but the incidence of urgent or high anal straining feeling in the PPH+Block group was significantly higher than that of the PPH group (P<0.05). ④ Medium- and long-term recurrence rate: the recurrence rate of 1-year after operation was similar between these2 groups (P>0.05), but the recurrence rate of 3-year after operation in the PPH+Block group was significantly lower than that of the PPH group (P<0.05). Conclusions The medium clinical effect has no obvious difference between PPH+Block and PPH operation, but the long-term recurrence rate of the former is lower than that of the latter, and the medium- and long-term effect is stable in PPH+Block operation for ODS caused by RE.

关键词: 出口梗阻型便秘; 吻合器痔上黏膜环形切除术; 直肠闭式修补术; 直肠前突; 临床疗效

Key words: obstructed defecation syndrome; procedure for prolapse and hemorrhoids; Block operation; rectocele; clinical effect

引用本文: 李晓军, 范雷涛, 李春雨. 吻合器痔上黏膜环形切除术联合直肠闭式修补术治疗出口梗阻型便秘的中远期疗效比较. 中国普外基础与临床杂志, 2018, 25(2): 202-206. doi: 10.7507/1007-9424.201708027 复制

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