盆底重建联合吻合器痔上黏膜环切术治疗Ⅱ、Ⅲ度直肠脱垂的临床分析
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摘要
目的观察盆底重建联合吻合器痔上黏膜环切术(procedure for prolapse and hemorrhoids,PPH)治疗Ⅱ、Ⅲ度直肠脱垂的效果以及对患者炎性及应激反应的影响。方法选取Ⅱ、Ⅲ度直肠脱垂患者208例,随机分为观察组和对照组各104例,观察组行盆底重建联合PPH治疗,对照组行直肠悬吊联合肛门紧缩术治疗,比较2组治疗效果、术后炎症细胞因子水平及应激反应指标。结果观察组一次修补成功率明显高于对照组,术后并发症发生率明显低于对照组,差异均有统计学意义(P<0.05)。治疗后2组皮质醇(cortisol,COR)、去甲肾上腺素(norepinephrine,NE)、前列腺素E2(prostaglandin E2,PGE2)、白细胞介素6(interleukin-6,IL-6)、白细胞介素10(interleukin-10,IL-10)及C反应蛋白(C-reactive protein,CRP)水平较治疗前明显升高,差异均有统计学意义(P<0.05);2组间COR、NE、PGE2、IL-6、IL-10及CRP水平差异均无统计学意义(P>0.05)。结论重建盆底联合PPH可有效治疗Ⅱ、Ⅲ度直肠脱垂患者,并能降低患者术后并发症发生率及复发率,且对术后患者炎症及应激反应无明显影响,在Ⅱ、Ⅲ度直肠脱垂治疗中较直肠悬吊联合肛门缩紧术优势明显。
Objective To observe the therapeutic effect of pelvic floor reconstruction in combined with procedure for prolapse and hemorrhoids(PPH)in the treatment of Ⅱ and Ⅲdegree rectal prolapse and the effect on the inflammation and stress reaction.Methods A total of208 patients with rectal prolapseⅡandⅢ degrees were randomly divided into observation group(104 cases)and control group(104 cases).The patients in the observation group were given pelvic floor reconstruction in combined with PPH,while the patients in the control group were given rectal suspension in combined with anus reduces technique.The effectiveness in the two groups was compared.The postoperative inflammatory cytokines and stress reaction indicators in the two groups were compared in order to evaluate the effects.Results The success rate of primary repair in the observation group was significantly higher than that of the control group,the incidence of postoperative complications was significantly lower than that of the control group,the difference was statistically significant(P<0.05).The levels of cortisol(COR),norepinephrine(NE),prostaglandin E2(PGE2),interleukin-6(IL-6),interleukin-10(IL-10)and C-reactive protein(CRP)in the two groups after treatment were significantly higher than those before treatment(P<0.05).There were no significant differences in COR,NE,PGE2,IL-6,IL-10 and CRP between the two groups(P>0.05).Conclusion The pelvic floor reconstruction in combined with PPH can effectively treat Ⅱ,Ⅲ rectal prolapse in various degrees,reduce the occurrence rate and recurrence rate of postoperative complications.There was no obvious effect on postoperative inflammation and stress response,and has more obvious advantage when compared with Ⅱ,Ⅲrectal suspension in combined with anus reduces technique.
Objective To observe the therapeutic effect of pelvic floor reconstruction in combined with procedure for prolapse and hemorrhoids(PPH)in the treatment of Ⅱ and Ⅲdegree rectal prolapse and the effect on the inflammation and stress reaction.Methods A total of208 patients with rectal prolapseⅡandⅢ degrees were randomly divided into observation group(104 cases)and control group(104 cases).The patients in the observation group were given pelvic floor reconstruction in combined with PPH,while the patients in the control group were given rectal suspension in combined with anus reduces technique.The effectiveness in the two groups was compared.The postoperative inflammatory cytokines and stress reaction indicators in the two groups were compared in order to evaluate the effects.Results The success rate of primary repair in the observation group was significantly higher than that of the control group,the incidence of postoperative complications was significantly lower than that of the control group,the difference was statistically significant(P<0.05).The levels of cortisol(COR),norepinephrine(NE),prostaglandin E2(PGE2),interleukin-6(IL-6),interleukin-10(IL-10)and C-reactive protein(CRP)in the two groups after treatment were significantly higher than those before treatment(P<0.05).There were no significant differences in COR,NE,PGE2,IL-6,IL-10 and CRP between the two groups(P>0.05).Conclusion The pelvic floor reconstruction in combined with PPH can effectively treat Ⅱ,Ⅲ rectal prolapse in various degrees,reduce the occurrence rate and recurrence rate of postoperative complications.There was no obvious effect on postoperative inflammation and stress response,and has more obvious advantage when compared with Ⅱ,Ⅲrectal suspension in combined with anus reduces technique.
引文
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[6]刘丛丛,李国栋,李元涛.电针治疗直肠脱垂术后肛门不完全失禁36例[J].中国针灸,2016,36(1):55.
[7]Gultekin FA,Wong MT,Podevin J,et al.Safety of laparoscopic ventral rectopexy in the elderly:results from a nationwide database[J].Dis Colon Rectum,2015,58(3):339-343.
[8]黎华,宗亚光,王夫景.吻合器痔上黏膜环切联合黏膜环缩术治疗完全性直肠脱垂[J].中国医师杂志,2016,18(2):269-270.
[9]李柏,孙迪,陈雷,等.双补片法治疗成人重度直肠脱垂的疗效观察[J].中华胃肠外科杂志,2016,19(4):464-465.
[10]王永明,江从庆.经会阴吻合器直肠脱垂切除术治疗完全性直肠脱垂的临床分析[J].临床外科杂志,2017,25(3):212-214.
[2]Tsunoda A,Kusanagi H.Perianal procedure for the treatment of rectal prolapse[J].Nihon Geka Gakkai Zasshi,2015,116(4):267-268.
[3]余洪艳,韦俊武.消痔灵改良注射法联合括约肌修补术治疗Ⅲ度直肠脱垂[J].中国中西医结合外科杂志,2016,22(2):164-166.
[4]Wang ZG,Zhang Y,Zeng XD,et al.Clinical observations on the treatment of prolapsing hemorrhoids with tissue selecting therapy[J].World J Gastroenterol,2015,21(8):2490-2496.
[5]Lord A,Hompes R,Arnold S,et al.Ultra-low anterior resection with coloanal anastomosis for recurrent rectal prolapse in a young woman with colitis cystica profunda[J].Ann R Coll Surg Engl,2015,97(2):e32-e33.
[6]刘丛丛,李国栋,李元涛.电针治疗直肠脱垂术后肛门不完全失禁36例[J].中国针灸,2016,36(1):55.
[7]Gultekin FA,Wong MT,Podevin J,et al.Safety of laparoscopic ventral rectopexy in the elderly:results from a nationwide database[J].Dis Colon Rectum,2015,58(3):339-343.
[8]黎华,宗亚光,王夫景.吻合器痔上黏膜环切联合黏膜环缩术治疗完全性直肠脱垂[J].中国医师杂志,2016,18(2):269-270.
[9]李柏,孙迪,陈雷,等.双补片法治疗成人重度直肠脱垂的疗效观察[J].中华胃肠外科杂志,2016,19(4):464-465.
[10]王永明,江从庆.经会阴吻合器直肠脱垂切除术治疗完全性直肠脱垂的临床分析[J].临床外科杂志,2017,25(3):212-214.