直肠黏膜剥除肌层折叠术联合直肠黏膜环切术治疗完全性直肠脱垂的疗效分析
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摘要
目的探讨直肠黏膜剥除肌层折叠术(Delorme)+直肠黏膜环切术(PPH)对完全性直肠脱垂患者治疗的疗效分析。方法回顾性分析2015年1月至2017年1月直肠脱垂患者60例资料,根据手术方式分为行Delorme术+PPH术的患者为研究组,仅行Delorme术的患者为对照组,各30例。使用SPSS20. 0统计软件分析,术后30 d排便情况、肛门潮湿及坠涨评分比较采用均数±标准差表示,组间采用独立t检验;手术治愈率、术后疼痛比较采用χ2检验。以P <0. 05差异有统计学意义。结果术后研究组患者治愈率100%显著高于对照组83. 3%(P <0. 05);研究组患者在术后3 d、7 d疼痛度显著低于对照组(P <0. 05);术后30 d,研究组患者控便能力、排便次数及时间、术后肛门潮湿度及坠涨情况评分、术后不良反应等均显著优于对照组,差异有统计学意义(P <0. 05)。结论 Delorme术联合PPH治疗完全性直肠脱垂较患者,疗效更为确切,显著提高患者手术治愈率,增强术后患者的排便能力,降低患者疼痛度,有效减少并发症及不良反应。
Objective To investigate the effect of Delorme( rectal mucosa stripping) + PPH( rectal mucosal loop) operation for patients with complete rectal prolapse. Methods Retrospective analysis were performed in 60 cases of rectal prolapse patients from January 2015 to January 2017,according to the surgical method was divided into Delorme + PPH study group( 30 cases) and Delonme control group( 30 cases). Clinical data were analyzed by using statistical software SPSS 20. 0. Measurement data such as Postoperative 30 d defecation condition,anus dampness and fall score were expressed as mean ± standard deviation,and independent t test was used for comparison between the groups. Count data,such as curative rate and postoperative pain rate were expressed as %,and were examined by using χ2test. A P value <0. 05 was considered as statistically significant difference. The curative rate of the study group was 100%,which was significantly higher than that of the control group( 83. 3%)( P < 0. 05). The pain level of POD3 d and POD 7d in the study group was significantly lower than those in the control group respectively( P <0. 05). POD 30 d,the patient's ability to control stool,the number of defecation,the time of defecation,the humidity and fall of the anus,and postoperative complications in the study group were all significantly better than those in the control group,with significant difference( P < 0. 05). Conclusion Delorme combined with PPH in the treatment of complete rectal prolapse was more effective for patients with complete rectal prolapse. It could significantly improve the curative rate,enhance the defecation ability,and reduce pain of patients,with less complications and adverse reactions.
Objective To investigate the effect of Delorme( rectal mucosa stripping) + PPH( rectal mucosal loop) operation for patients with complete rectal prolapse. Methods Retrospective analysis were performed in 60 cases of rectal prolapse patients from January 2015 to January 2017,according to the surgical method was divided into Delorme + PPH study group( 30 cases) and Delonme control group( 30 cases). Clinical data were analyzed by using statistical software SPSS 20. 0. Measurement data such as Postoperative 30 d defecation condition,anus dampness and fall score were expressed as mean ± standard deviation,and independent t test was used for comparison between the groups. Count data,such as curative rate and postoperative pain rate were expressed as %,and were examined by using χ2test. A P value <0. 05 was considered as statistically significant difference. The curative rate of the study group was 100%,which was significantly higher than that of the control group( 83. 3%)( P < 0. 05). The pain level of POD3 d and POD 7d in the study group was significantly lower than those in the control group respectively( P <0. 05). POD 30 d,the patient's ability to control stool,the number of defecation,the time of defecation,the humidity and fall of the anus,and postoperative complications in the study group were all significantly better than those in the control group,with significant difference( P < 0. 05). Conclusion Delorme combined with PPH in the treatment of complete rectal prolapse was more effective for patients with complete rectal prolapse. It could significantly improve the curative rate,enhance the defecation ability,and reduce pain of patients,with less complications and adverse reactions.
引文
[1]王春敬,王夫景,张好刚,等.吻合器痔上黏膜环切术加柱状缝合术治疗完全型直肠脱垂临床疗效观察[J].中国医师进修杂志,2016,39(7):655-655,658.
[2] Bian-Fang YU,Jia ZB,Qing-Gang LI,et al. The clinic research of prolapse and hemorrhoids methods in the treatment of incarceration of internal hemorrhoids[J]. Journal of Taishan Medical College,2018,8(7):36-38.
[3]魏巍,李荣先,李红梅,等.改良Delorme手术治疗直肠脱垂临床疗效观察[J].新乡医学院学报,2017,34(8):734-737.
[4]毛国红,刘惠敏,曾科,等.消痔灵注射联合PPH治疗直肠脱垂疗效研究[J].陕西中医,2017,38(4):498-499.
[5] Surridge D. PPH:WHERE DID IT GO WRONG?[J]. South African Journal of Surgery,2017,55(2):55-55.
[6]张燕生,韩宝,田振国.中医肛肠科常见病诊疗指南[J]. 2012,11(6):33-35.
[7]顾新,佟方,李京平,等.疼痛的评定[J].现代康复,2000,4(1):86-87.
[8]闵莉,林雪娟,杜含光,等.中医诊断学发展中存在的问题与展望[J].中医杂志,2015,56(4):271-273.
[9]毕轶,杨国兴,王钰红,等. PPH对痔疮合并直肠脱垂患者术后并发症、疼痛程度及复发率的影响[J].检验医学与临床,2017,14(7):1039-1040.
[10]吴艳,马丽,常海霞.术前负性情绪对直肠黏膜脱垂患者吻合器痔上黏膜环切术后疼痛的影响[J].医学临床研究,2016,33(5):901-903.
[11]郑雪平,王业皇,丁曙晴,等. Delorme术对直肠脱垂患者肛门功能的影响[J].江苏医药,2015,41(1):105-106.
[12] Avgoustou C. Predisposing and aetiologic factors for haemorrhoidal recurrence after procedure for prolapse and haemorrhoids(PPH)[J]. Hellenic Journal of Surgery,2016,88(3):147-156.
[13] Hou H,Anorectum DO. Clinical effect comparison of tissue-selecting therapy stapler and procedure for prolapse and hemorrhoids with stapler in the treatment of haemorrhoids[J]. China Modern Medicine,2016,12(9):45-47.
[14]袁鹏,付琦,李春雨,等.经肛三联术与Delorme术治疗成人Ⅱ、Ⅲ度直肠脱垂的疗效评价[J].结直肠肛门外科,2015,21(2):87-90.
[15]魏巍,李荣先,李红梅,等.改良Delorme手术治疗直肠脱垂临床疗效观察[J].新乡医学院学报,2017,34(8):734-737.
[16] Kobayashi Y,Yuzawa K,Yoneyama S,et al. A Case of a Pararectal Cyst Developed after Procedure for Prolapse and Hemorrhoids(PPH)for Internal Hemorrhoid[J]. Nihon Rinsho Geka Gakkai Zasshi,2017,78(1):98-104.
[2] Bian-Fang YU,Jia ZB,Qing-Gang LI,et al. The clinic research of prolapse and hemorrhoids methods in the treatment of incarceration of internal hemorrhoids[J]. Journal of Taishan Medical College,2018,8(7):36-38.
[3]魏巍,李荣先,李红梅,等.改良Delorme手术治疗直肠脱垂临床疗效观察[J].新乡医学院学报,2017,34(8):734-737.
[4]毛国红,刘惠敏,曾科,等.消痔灵注射联合PPH治疗直肠脱垂疗效研究[J].陕西中医,2017,38(4):498-499.
[5] Surridge D. PPH:WHERE DID IT GO WRONG?[J]. South African Journal of Surgery,2017,55(2):55-55.
[6]张燕生,韩宝,田振国.中医肛肠科常见病诊疗指南[J]. 2012,11(6):33-35.
[7]顾新,佟方,李京平,等.疼痛的评定[J].现代康复,2000,4(1):86-87.
[8]闵莉,林雪娟,杜含光,等.中医诊断学发展中存在的问题与展望[J].中医杂志,2015,56(4):271-273.
[9]毕轶,杨国兴,王钰红,等. PPH对痔疮合并直肠脱垂患者术后并发症、疼痛程度及复发率的影响[J].检验医学与临床,2017,14(7):1039-1040.
[10]吴艳,马丽,常海霞.术前负性情绪对直肠黏膜脱垂患者吻合器痔上黏膜环切术后疼痛的影响[J].医学临床研究,2016,33(5):901-903.
[11]郑雪平,王业皇,丁曙晴,等. Delorme术对直肠脱垂患者肛门功能的影响[J].江苏医药,2015,41(1):105-106.
[12] Avgoustou C. Predisposing and aetiologic factors for haemorrhoidal recurrence after procedure for prolapse and haemorrhoids(PPH)[J]. Hellenic Journal of Surgery,2016,88(3):147-156.
[13] Hou H,Anorectum DO. Clinical effect comparison of tissue-selecting therapy stapler and procedure for prolapse and hemorrhoids with stapler in the treatment of haemorrhoids[J]. China Modern Medicine,2016,12(9):45-47.
[14]袁鹏,付琦,李春雨,等.经肛三联术与Delorme术治疗成人Ⅱ、Ⅲ度直肠脱垂的疗效评价[J].结直肠肛门外科,2015,21(2):87-90.
[15]魏巍,李荣先,李红梅,等.改良Delorme手术治疗直肠脱垂临床疗效观察[J].新乡医学院学报,2017,34(8):734-737.
[16] Kobayashi Y,Yuzawa K,Yoneyama S,et al. A Case of a Pararectal Cyst Developed after Procedure for Prolapse and Hemorrhoids(PPH)for Internal Hemorrhoid[J]. Nihon Rinsho Geka Gakkai Zasshi,2017,78(1):98-104.