摘要
报告65例经腹手术治疗便秘的患者,其中出口梗阻型(OOC)50例,结肠慢通过型(STC)15例.女性为男性之6倍.OOC排粪造影发现:IRP50;RC13;肠疝3;DPS24.STC排粪造影发现:IRP12;DPS10;巨乙状结肠1.术中OOC发现:IRP(直肠松弛与可套迭)50;33例有子宫者均脱垂及后倒;盆底下降50;盆底疝13.STC手术发现:IRP12;12例有子宫者均脱垂及后倒;盆底下降14;1例男性伴巨乙状结肠者无盆底变化.结合盆腔造影20例:DPS14,盆底疝12.15例STC结肠传输试验均5d以上才排出.讨论了PFP的有关问题,提出排粪造影结合盆腔造影有助于诊断.认为OOC和SIC常伴不同程度的PFP,PFP可与器官移位:IRP、UP、RC、盆底疝等变化并存.对便秘者手术应有盆底脱垂的观念包括功能性直肠悬吊,子宫前倾位固定、盆底适度抬高、切除冗长或无功能的结肠等同时完成,并强调术后加强肛提肛锻炼,不用力摒便.
of the 65 patients with constipation receiving abdominal operation, 50 patients sufferedfrom outlet obstructive constipation (OOC) and 15 patients from colonic slow transit constipation(STC). Defecographies indecate, all of the 50 cases with OOC had internal rectal prolapse(IRP), and 13 patients rectocde (RC), 3 patients enterocele, 24 patients descending perineumsyndrome (DPS). During abdominal operation, the follow changes of 50 OOC were found: uterusprolapse (UP) in 33 patients, descending pelvic floor and IRP in 50 patients, pelvic floor herniain 13 patients. A mong the 15 patients with colonic STC, 12 patients had IRP, 14 patientsDPS. And during abdominal operations, 12 patients were found to have IRP, 12 patients UP and14 patients descending pelvic floor. 1 male patient with megasigmoid had no pelvic change of 20patients receiveding defecograghies and pelvicography, pelvic floor hernia 14 were found tohave.It was believed that defecography and pelvicography were a helpful technique in the diagnosis ofPFP. These results showed that OOC and STC were always accompanied by PFP, and PFP maybe accompanied by IRP, UP, RC or pelvic floor hernia. Patieats with constipation could be treatedby functional rectopexy, forward uteropexy, proper raise of the level of pelvic floor, resection ofdysfanctional colon and so on. These techniques must be performed stimultaneously. It must beemphasized that patients should enhance exercise of levator and not strain during defecation
出处
《大肠肛门病外科杂志》
1998年第2期1-4,共4页
Journal of Coloproctological Surgery
