经肛门腔镜直线切割缝合器治疗直肠前突的临床疗效分析被引量：6

The clinical efficacy of transanal linear stapler repairing the rectocele patients

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摘要目的研究经肛门腔镜直线切割缝合器直肠前壁部分切除术治疗成年女性直肠前突所致功能性排便障碍型便秘的临床疗效。方法回顾性分析2012年9月-2013年7月在杭州市第三人民医院接受经肛门腔镜直线切割缝合器直肠前突部分切除术治疗的34例成年女性直肠前突患者的临床资料,通过Cleveland便秘评分、患者满意度调查和影像学改善情况来评价术后便秘缓解状况及手术效果。结果 34例患者手术顺利,手术时间为(43±9)min,术中失血量为(37±9)ml。术后直肠前突体征均消失,无大出血、肛周脓肿、直肠阴道瘘、术后性交痛、直肠狭窄、肛门狭窄、肛门失禁等并发症及围手术期死亡病例,术后疼痛评分平均为(4.7±1.5)分,1例患者术后排便疼痛持续3个月后自行缓解。术后患者Cleveland便秘评分较术前改善(P<0.01),术后患者直肠前突深度较术前减少(P<0.01),术后患者满意度调查评分总体满意率为82.3%。结论经肛门腔镜直线切割缝合器直肠前壁部分切除术是治疗成年女性以直肠前突为主的功能性排便障碍型便秘的有效术式,具有安全、简便、手术时间短、术后疼痛轻及并发症少等特点。 [ Objective ] To evaluate the clinical efficacy of transanal rectocele repair by linear stapler in the patients with functional constipation of obstructed defecation. [Methods] Between September 2012 and July 2013, 34 adult female patients with symptomatic rectocele were enrolled for this study in Third People＇s Hospital of Hangzhou. The patient＇s general information,Including cleveland constipation score, patient satisfaction survey and defecography improvement were recorded to evaluate postoperative constipation relief condition and results of operations. [ Results ] 34 cases of patients with successful surgery, operative time was （43 ±9） min, intraoperative blood loss was （37±9） ml. Postoperative rectocele was disappeared.There was no bleeding, no perianal abscess, no rectovaginal fistula, no dyspareunia ,no rectal and anal stenosis, no incontinence and other complications in postoperative time with the patient.The postoperative pain score was （4.7±1.5） points. One patient got defecation pain which lasted three months.There was significant difference between preoperative and postoperative Cleveland score （P 〈0.01）. Postoperative rectocele depth reduced significantly （P 〈0.01）. Postoperative patient satisfaction survey rated the over-all satisfaction rate was 82.3%. [Conclusion] Transanal repair of rectocele using a linear stapler is an easy, safe, and useful procedure for the correction of symptomatic rectocele. The procedure has characteristic of shorter time, less postoperative pain and complications.

作者商善良杨关根廖秀军裘建明杨琴燕张秀峰丁磊张延祥

机构地区安徽医科大学附属杭州市第三人民医院肛肠外科

出处《中国内镜杂志》北大核心 2015年第5期449-453,共5页 China Journal of Endoscopy

基金国家自然科学基金青年基因项目(No:81101876) 杭州市卫生局科技计划项目(No:2011A027) 杭州市医学重点专科专病计划(No:20120533Q06)

关键词直肠前突腔镜直线切割缝合器便秘 rectocele linear stapler constipation

分类号 R657.17 [医药卫生—外科学]

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参考文献17

1RENZI A, IZZO D, DI SARNO G, et al. Stapled transanal rectal resection to treat obstructed defecation caused by rectal intussus- ception and reetocele [J]. Int J Coloreetal Dis, 2006, 21 (7): 661-667.
2AYAV A, BRESLER L, BRUNAUD L, et at. Long-term results of transanal repair of rectocele using linear stapler [J]. Dis Colon Rectum, 2004, 47(6): 889-894.
3BOCCASANTA P, VENTURI M. Stapled transanal rectal reset- tion in solitary rectal ulcer associated with prolapse of the rec- tum: A prospective study[J]. Dis Colon Rectum, 2008, 51 (3): 348-354.
4DROSSMAN DA. The functional gastrointes disorders and the Rome III process[J]. Gastroenterology, 2006, 130(5): 1377-1390.
5BIJUR PE, SILVER W, GALLAGHER EJ, et al. Reliability of the visual analog scale for measurement of acute pain [J]. Acad Emerg Med, 2001, 8(12): 1153-1157.
6AGACHAN F, CHEN T, PFEIFER J, et al. A constipation scor- ing system to simplify evaluation and management of constipated patients[J]. Dis Colon Rectum, 1996, 39(6): 681-685.
7LAUBERT T, KLEEMANN M, ROBLICK UJ, et al. Obstructive defecation syndrome: 19 years of experience with laparoscopic resection reetopexy[J]. Tech Coloproetol, 2013, 17(3): 307-314.
8LAUBERT T, KLEEMANN M, ROBLICK UJ, et al. Laparoseopie resection rectopexy as treatment for obstructive defecation syn- drome[J]. Zentralbl Chir, 2012, 137(4): 357-363.
9ALTMAN D, MELLGREN A, ZETYERSTROM J. Rectocele re- pair using biomaterial augmentation: current documentation and clinical experience[J]. Obstet Gyneccl Surv, 2005, 60(11): 753-760.
10FOX SD, STANTON SL. Vault prolapse and rectocele: assess- ment of repair using sacrocolpopexy with mesh interposition[J]. BJOG, 2000, 107(11): 1371-1375.

二级参考文献22

1沈文洁,鲁永鲜.盆腔器官脱垂发病相关因素研究进展[J].国外医学（妇产科学分册）,2006,33(3):188-191. 被引量：27
2Douglas A．Drossman,蒋晓玲（译）,萧树东（校）.罗马Ⅲ：新的标准[J].胃肠病学,2006,11(12):705-707. 被引量：514
3肖元宏,刘洲禄,刘贵麟,彭少林,王政,彭正,臧传波,夏少友,张艳君.成人盆底痉挛综合征型便秘的分型及其病理生理机制[J].世界华人消化杂志,2007,15(7):767-771. 被引量：7
4Gonzalez-Argente FX,Jain A,Nogueras JJ,et al.Prevalence and severity of urinary incontinence and pelvic genital prolapse in females with anal incontinence or rectal prolapse[J].Dis Colon Rectum,2001,44(7):920-926.
5Petros PE,Ulmsten UI.An integral theory and its method for the diagnosis and management of female urinary incontinence[J].Scand J Urol Nephrol Suppl,1993,153:1-93.
6Petros PP,Skilling PM.Pelvic floor rehabilitation in the female according to the integral theory of female urinary incontinence.First report[J].Eur J Obstet Gynecol Reprod Biol,2001,94(2):264-269.
7Chene G,Amblard J,Tardieu AS,et al.Long-term results of tension-free vaginal tape (TVT) for the treatment of female urinary stress incontinence[J].Eur J Obstet Gynecol Reprod Biol,2007,134(1):87-94.
8Davis K,Kumar D.Pelvic floor dysfunction:a conceptual framework for collaborative patient-centred care[J].J Adv Nurs,2003,43(6):555-568.
9Roman H,Michot F.Long-term outcomes of transanal rectocele repair[J].Dis Colon Rectum,2005,48(3):510-517.
10Chan CL,Scott SM,Williams NS,et al.Rectal hypersensitivity worsens stool frequency,urgency,and lifestyle in patients with urge fecal incontinence[J].Dis Colon Rectum,2005,48(1):134-140.