联合术式治疗盆底肌功能紊乱所致出口梗阻型便秘150例临床研究
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摘要
目的探讨经会阴入路修补术合并耻骨直肠肌松解术对盆底肌功能紊乱致出口梗阻型便秘的疗效。方法选择2017年4月-2017年10月新疆医科大学第一附属医院肛肠科收治的经肛门检查确诊为盆底肌功能紊乱所致出口梗阻型便秘患者150例,对患者术前术后的排便时间、直肠肛管测压等客观指标进行对比,并对患者术后1、6、12个月的排便情况进行随访。结果患者术后排便时间较术前明显缩短,差异具有统计学意义(P<0.05),术后患者Longo ODS评分明显低于术前(P<0.05),测压提示反常收缩明显好于术前(P<0.05),术后患者的肛管舒张压、肛管最大收缩压、肛管静息压较术前差异有统计学意义(P<0.05),但术后患者的直肠静息压与术前相比差异无统计学意义(P>0.05)。分别于术后1、6、12个月进行随访,患者排便情况均好于术前(P<0.05),所有患者均未出现肛门大出血、肛门失禁等情况。结论会阴入路修补术合并耻骨直肠肌松解术可有效改善患者盆底肌功能紊乱情况,并缓解出口梗阻,改善患者排便困难,对保守治疗欠佳的盆底肌功能紊乱的便秘患者是首选治疗方案。
Objective Effect of perineal approach combined with puborectalis muscle release in the treatment of outlet obstruction constipation caused by pelvic floor muscle dysfunction was observed. Methods 150 patients with anus bowel division after rectal examination diagnosis of pelvic floor muscle dysfunction caused by type outlet obstruction constipation were selected from April 2017 to October 2017 in the First Affiliated Hospital of Xinjiang Medical University. They were followed-up after 1, 6, 12 months of defecation, respectively and the postoperative defecation time, preoperative, postoperative rectal pressure of the patients were compared. Results Postoperative defecation time was significantly shorter than that before operation(P<0.05). Postoperative patients Longo ODS score significantly lower than that of the preoperative patients score(P<0.05). Pressure measurement indicated that abnormal contraction was significantly better than that before surgery(P<0.05), and postoperative anal diastolic pressure, maximum anal systolic pressure, and anal resting pressure showed statistically significant differences compared with that before surgery(P<0.05), but there was no significant difference in resting pressure of rectum between patients after operation and those before operation(P>0.05). Postoperative patientsin 1, 6, 12 months follow-up defecation were better than that of preoperative patients, respectively(P<0.05). No severe anal hemorrhage or incontinence was found in all patients. Conclusion Perineal approach repair combined with puborectal muscle release can effectively improve pelvic floor muscle dysfunction, alleviate outlet obstruction and improve the difficulty of defecation. Conservative treatment of constipation patients with pelvic floor muscle dysfunction is the preferred treatment.
Objective Effect of perineal approach combined with puborectalis muscle release in the treatment of outlet obstruction constipation caused by pelvic floor muscle dysfunction was observed. Methods 150 patients with anus bowel division after rectal examination diagnosis of pelvic floor muscle dysfunction caused by type outlet obstruction constipation were selected from April 2017 to October 2017 in the First Affiliated Hospital of Xinjiang Medical University. They were followed-up after 1, 6, 12 months of defecation, respectively and the postoperative defecation time, preoperative, postoperative rectal pressure of the patients were compared. Results Postoperative defecation time was significantly shorter than that before operation(P<0.05). Postoperative patients Longo ODS score significantly lower than that of the preoperative patients score(P<0.05). Pressure measurement indicated that abnormal contraction was significantly better than that before surgery(P<0.05), and postoperative anal diastolic pressure, maximum anal systolic pressure, and anal resting pressure showed statistically significant differences compared with that before surgery(P<0.05), but there was no significant difference in resting pressure of rectum between patients after operation and those before operation(P>0.05). Postoperative patientsin 1, 6, 12 months follow-up defecation were better than that of preoperative patients, respectively(P<0.05). No severe anal hemorrhage or incontinence was found in all patients. Conclusion Perineal approach repair combined with puborectal muscle release can effectively improve pelvic floor muscle dysfunction, alleviate outlet obstruction and improve the difficulty of defecation. Conservative treatment of constipation patients with pelvic floor muscle dysfunction is the preferred treatment.
引文
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[11] 张远耀,魏东,赵国华.耻骨直肠肌切断、断端包埋治疗耻骨直肠肌综合征 150 例疗效观察[J].医学信息,2010,5(12):3565.
[12] 彭艳飞,王慧玲.后方横切口切除部分耻骨直肠肌及掩埋断端治疗耻骨直肠肌综合征 15 例[J].云南中医中药杂志,2012,33(2):30.
[13] WEI-CHENG L,SONG-LIN W,SM Y,et al.Transanal surgery for obstructed defecation syndrome:Literature review and a single-center experience[J].World J Gastroenterol,2016,22(35):7983-7998.
[2] BOCCASANTA P,VENTURI M,CALABRO G,et al.Stapled transanal rectal resection in solitary rectal ulcer associated with prolapse of the rectum:a prospective study[J].Dis Colon Rectum,2008,51(3):348-354.
[3] 钱群,陈文豪.耻骨直肠肌综合征:出口梗阻型便秘的难点[J].临床外科杂志,2018,26(4):250-253.
[4] ROME-FOUNDATION R.Guidelines-Rome III diagnostic criteria for functional gastrointestinal disorders[J].J Gastrointestin Liver Dis,2006,15(3):307-312.
[5] 张东铭.盆底与肛门病学[M].贵阳:贵州科技出版社,2004:334.
[6] ASCIORE L,PESCATORI L C,PESCATORI M.Semi-closed bilateral partial miotomy of the puborectalis for anismus:a pilot study:Partial miotomy of the puborectalis for anismus[J].Int J Colorectal Dis,2015,30(12):1729-1734.
[7] 中国医师协会肛肠医师分会.便秘外科诊治指南(2017)[J].中华胃肠外科杂志,2017,20(3):241-243.
[8] 徐明凤.经骶尾入路离断部分耻直肌治疗耻骨直肠肌综合征的临床疗效[J].结直肠肛门外科,2014,20(5):326-327.
[9] 魏志强,孔斌.耻骨直肠肌挂线治疗耻骨直肠肌综合征 56 例临床分析[J].山西医药杂志,2011,40(2):151.
[10] 魏巍,李荣先,尚秀娟,等.改良术式治疗耻骨直肠肌综合征的疗效[J].世界华人消化杂志,2015(2):343-347.
[11] 张远耀,魏东,赵国华.耻骨直肠肌切断、断端包埋治疗耻骨直肠肌综合征 150 例疗效观察[J].医学信息,2010,5(12):3565.
[12] 彭艳飞,王慧玲.后方横切口切除部分耻骨直肠肌及掩埋断端治疗耻骨直肠肌综合征 15 例[J].云南中医中药杂志,2012,33(2):30.
[13] WEI-CHENG L,SONG-LIN W,SM Y,et al.Transanal surgery for obstructed defecation syndrome:Literature review and a single-center experience[J].World J Gastroenterol,2016,22(35):7983-7998.