改良STARR手术治疗直肠前突的临床研究
详细信息    本馆镜像全文|  推荐本文 |  |   获取CNKI官网全文
摘要
目的:观察和评价改良STARR手术治疗直肠前突的临床疗效及安全性。
     方法:将符合纳入标准的57例女性直肠前突患者随机分成两组,治疗组29例,对照组28例。治疗组行改良STARR手术治疗,对照组行STARR手术治疗。术前及术后1周、1月、3月、6月均进行ODS评分,两组间手术前后评分对比,并比较其术前及术后6个月排粪造影结果,观察其临床疗效,同时观察其术后并发症,评价其治疗效果及安全性。
     结果:患者治疗后ODS症状评分较治疗前显著降低,两组疗效对比无明显差异(P>0.05),且两种手术术后并发症都少,近期随访无复发。
     结论:改良STARR手术治疗直肠前突,是一种临床疗效确切、并发症少、安全可靠的新方法,同STARR手术相比,具有操作更简单,手术时间更短,费用更低,治疗内痔、直肠粘膜内脱等合并症更彻底等优点。
Objective:To observe and judg the clinical efficacy and safety of the Improved STARR treatment on with obstructed defaecation syndrome caused by rectocele.
     Methods:The 57 patients met the inclusion criteria of women rectocele were randomly divided into two groups, treatment group,29 cases,28 patients in control group. STARR treatment group were improved surgical treatment, control group were STARR surgery. Preoperative and postoperative 1 week,1 month,3 months,6 months were carried out ODS score, score comparison between the two groups before and after surgery, and to compare their preoperative and postoperative 6 months defecography results, clinical efficacy, Postoperative complications were observed, to evaluate the therapeutic efficacy and safety.
     Results:ODS symptom scores after treatment than before treatment were significantly lower compared two groups no significant difference (P> 0.05), and two groups had fewer postoperative complications, the recent follow-up without recurrence.
     Conclusion:Improved STARR surgical treatment of rectoceleis a clinical efficacy, fewer complications, safe and reliable new method, with the STARR procedure, compared with more simple operation, a shorter operative time, lower cost, treatment of internal hemorrhoids, rectal mucosa More thoroughly in off the advantages of such complications.
引文
[1]Sarles JC, Amaud A, Selezneff, et al. Endorectal repair of rectocele Int J Colorectal Dis,1989,4:167-171.
    [2]徐琰,张连阳.直肠前突出的诊断和治疗现状.[J].中华普外科杂志,2002,17(11):701-703.
    [3]Douglasa OF. A clinical approach to constipation. Clinical Cornerstone,2002,4(4):11-21.
    [4]Delancey JO. Structural support of the urethra as it related to stress urinay inaontinence:the hammock hypothesis [J].Obstet Gynecol,1994.170(6):1713-1723.
    [5]Puigdollers A. Fernandez-Fraga X. Azpiroz F. Persistent symptoms of functional outlet obstruction after rectocele repair [J].Dis Colon rectum.2007.9(3):262-265.
    [6]Roman H. Michot F. Long-term outcomes of transanal retrocele repair [J].Dis Colon rectum.2005.48(3):510-517.
    [7]黄乃健主编.中国肛肠病学[M].济南:山东科学技术出版社,1996.1002.
    [8]张东铭,直肠阴道隔重建术治疗直肠前突的解剖学基础[J].结直肠肛门外科杂志,2007,13(5):328-329.
    [9]黄乃健主编.中国肛肠病学[M].济南:山东科学技术出版社1996.998-1999.
    [10]韦小燕等.109例便秘患者的排粪造影分析[J].放射学实 践.2007,22(1):52-53.
    [11]沈峰等.X线观察直肠前突的手术疗效[J].医学影像学杂志.2005,15(8):692-694.
    [12]Boccasanta P, Venturi M, Salamina G, et al. New trends in the surgical treatment of outlet obstruction:clinical and functional results of two novel transanal stapled techniques from a randomised controlled trial,2004,19:359-369
    [13]Gagliardi G, Pescatori M, Altomare DF, et al. Results, outcome pre-dictors. and complications after stapled transanal rectal resection for obstructed defecation. Dis Colon Rectum,2008,51:186-195
    [14]尹淑慧,赵克,候庆香,丁健华.吻合器经肛直肠切除术与经阴道手术治疗直肠前突的比较.中国普外基础与临床杂志,2010,17(2):129-132
    [15]王丽峰.STARR手术在直肠前突治疗中的应用.社区医学杂志,2010,8(13):33-34
    [16]唐清珠,子树明,顾成义,罗吉孔,唐世佳,崔龙.STARR手术治疗出口梗阻型便秘214例的临床分析.中华普外科手术学杂志(电子版),2010,4(3):34-37
    [17]汤献忠,李兴谦,杨清,王丹.STARR手术治疗排便障碍综合征的临床疗效观察.结直肠肛门外科,2010,16(4):217-219
    [18]林友彬,杨中权.STARR手术在直肠前突治疗中的应用.结直肠肛 门外科,2009,15(3):165-166
    [19]Longstreth GF, Thompson WG, Chey WD. Functional Bowel Disorders. In:Drossman DA eds. Rome Ⅲ:the functional gastrointestinal disorders. Mclean:Degnon Associates,2006.487-555.
    [20]国家中医药管理局.中医病症诊断疗效标准[M].南京:南京大学出版社,1994.11.
    [21]Boccasanta et al. STARR in Solitary Rectal Ulcer. The Ascrs. 2008,51:348-354.
    [22]杨新庆,田波.全国便秘诊治新进展学术研讨会(1999潍坊)会议纪要[J].大肠肛门病外科杂志,1999,5(4):1-3.
    [23]宫红彦等.3种术式治疗直肠前突的疗效对比观察[J].结直肠肛门外科杂志.2008,14(5):330.
    [24]张东铭.直肠阴道隔重建术治疗直肠前突的解剖学基础[J].结直肠肛门外科杂志.2007,13(5):328.
    [25]张东铭主编.盆底与肛门病学[M].贵阳.贵阳科技出版社出版,2000,300-305,
    [26]Zimmerman CW. Posterior vaginal reconstruction ustinguterosacral colpopexy:The new posterior repair. The first Sino-American meeting of pelvic reconstructive and gynecologic surgeries, 2005:196.
    [27]黄乃健主编.中国肛肠病学[M].济南:山东科技出版社出版, 1996.1002.
    [28]张连阳等.直肠前突、盆底与肛门病学[M].贵州科技出版社出版.2000,4:3001.
    [29]俞宝典等.开敞造瘘综合术矫治直肠前突为主便秘的疗效观察[J].上海中医药大学学报,2000,4(14):319-321.
    [30]刘建新.388例出口梗阻型便秘的治疗[J].中国肛肠病杂志,2000,20(1):26.
    [1]Sarles JC, Amaud A, Selezneff, et al. Endorectal repair of rectocele Int J Colorectal Dis,1989,4:167-171.
    [2]徐琰,张连阳.直肠前突出的诊断和治疗现状.[J].中华普外科杂志,2002,17(11):701-703.
    [3]Pucciani F, Rottoil ML, Bologna A, et al. Anterior rectocele and anorectal dysfunction. Int J colorectal Dis 1996,111 (1):1-9.
    [4]吕厚山主译.Marvin L. Corman.结肠与直肠外科学.[M].北京:人民卫生出版社:399-405
    [5]Aronld MW, Stewart WR, Aguilar PS. Rectocele repair:four years experience. Dis Colon Rectum,1990,33:684-687.
    [6]Mellgren A, AnzenB, Nilsson BY,et al. Results of rectocele repair:a prospective study.Dis Colon Rectum,1995,38:7-13.
    [7]Siproudhis L, Dautreme S, Report A, et al. Dyschezia and rectocecl-a marriage of convenience. Dis Colon Rectum,1993,36:1030-1036
    [8]Blatchford GJ, Cali RL, Christensen MA.直肠前膨出的外科治疗[J].大肠肛门病外科杂志,1996,3(1):61
    [9]吴青梅.直肠前突的流行病学调查研究.[J].江西中医药杂志,2005,6(36):19-20
    [10]戎兴元,姚忠民,贺诚.72例直肠前膨出的排粪造影分析[J].中国肛肠病杂志,1995,15(1):23-24
    [11]卢任华,万向荣,龙金春等.直肠前突239例分析[J].中华外科杂志,1990,28(2):102-104
    [12]陆金根.大肠肛门病研究新进展[M].上海中医药大学出版社,2003,309-311
    [13]黄乃健主编.中国肛肠病学[M].济南:山东科学技术出版社,1996.1002
    [14]张东铭,直肠阴道隔重建术治疗直肠前突的解剖学基础[J].结直肠肛门外科杂志,2007,13(5):328-329
    [15]方仕文,王华育,刘宣华.出口梗阻性便秘盆底形态研究及临床意义[J].中国实用外科杂志,2002,22(12):722
    [16]DeLancey JOL. Structural support of the urethra as itrelates to stress incontinence:the hammock hypothesis. Am J Obstet Gynecol,1994,170:1713-1723.
    [17]Block IR. Rectovaginal fistulas and rectoceles[J]. Dis Colon Rectum,1986,29 (7):707.
    [18]喻的洪,李实中.出口处便秘的外科治疗86例报告[J].上海医学,1989,(1):191
    [19]Murthy VK, Drkin BA, Smith LE, et al. Excellent outcome using selective criterin for rectocle repair. Dis Colon Rectum.1996,39:374-378
    [18]Shorvon PJ, McHugh S, Diamant NE, et al. Defecography in normal Volunteers:result and implications. Gur 1989,30:1737-1749.
    [19]张连阳,张胜本.直肠前突、盆底与肛门病学[M].贵州科技出版社,2000,4:3001
    [20]刘建新.388例出口梗阻性便秘的治疗[J].中国肛肠病杂志,2000,20(1):26
    [21]郭建军,张永平,焦旅忠等.排粪造影对直肠前突的诊断价值[J].上海医学影像,2005,14(2):145-146
    [22]尹修芳,曾光华,古绍明.直肠前突排粪造影的临床X线分析[J].泸州医学院学报,2004,27(2):161
    [23]黄乃健,孙洪生,李殿伟.直肠前突的临床研究[J].中国肛肠病杂志,2003,23(1):12
    [24]张东铭,主编.盆筋膜和盆会阴间隙.大肠肛门局部解剖与手术学[M].合肥:安徽技术出版社,1998,24
    [25]张燕生,主编.引起排便困难的盆底疾患·肛肠疾病研究新进展[M].北京:华夏出版社,1994,165
    [26]张东铭,主编,直肠前膨出手术、大肠肛门局部解剖与手术学[M].合肥:安徽科学技术出版社,1998,248
    [27]刘宝华.便秘的外科治疗研究进展[J].临床外科杂志,2009,17(4):226
    [28]杨新庆.直肠前壁膨出的诊治进展[J].中国实用外科杂志,1993,13(12):717-718.
    [29]尹健宝.补中益气汤加味治疗直肠前突86例[J].湖南中医杂志,2004,20(6):42-43.
    [30]高峰,黄如华,林巧媚.补中益气汤加减治疗出口梗阻性便秘96例[J].福建中医药,2004,35(2):309
    [31]Lan CW, Heymen S, AlabezO, et al. Prognostic significance of rectocele, intussusception, and abnormoal perineal descent in biofeedkaek treatment for constipated patients with paradoxical puborecaction. Dis Colon Rectum,2000,43:478-482.
    [32]Mimura T, Roy AJ, Storrie JB, et al. Treatment of impaired defecation associated with rectoclel by behavvorial retraining(biofeedback). Dis Colon Rectam,2000,43:1267-1272.
    [33]邓建中,喻德洪.直肠前突修补病人的选择[J].中国肛肠病杂志,2001,21(1):271.
    [34]贺平,罗励.注射加粘膜柱状缝合治疗直肠前突78例[J].中国中西医结合外科杂志,2004,10(2):85-86.
    [35]付启龙,贾占波,董洪新.直肠前突手术治疗方法[J].中华医学研究杂志,2003,10(3):897-899.
    [36]刘昱,刘文龙.经肛门闭式荷包缝合术治疗直肠前突51例[J].中国肛肠病杂志,1998,18(1):5.
    [37]李友谊.三步联合法经肛门治疗直肠前突36例[J].中国肛肠病杂志,1998.18(1):5
    [38]沈峰.高位扩肛挂线法治疗直肠前突40例[J].中国肛肠病杂志,1999,19(1):29
    [39]王爱磊,陆庆萍,白国民 改良闭式修补术并益气增液中药治疗 重度直肠前突.云南中医学院学报 2010,6(33):47-49.
    [40]Sehapayah S. Transrectal repair of rectocele:anextendecl armamentarium of colorectal surgeons[J].Dis Colon Retim,1985, (28):422.
    [41]罗奎.直肠前突开放性修补术的改良[J].中国肛肠病杂志.1996,16(5):16.
    [42]张鹏.涤纶补片在直肠前突修补中的运用[J].中国肛肠病杂志,1998,18(1):35.
    [43]Altman D等.胶原补片修补直肠前突[J].大肠肛门病外科杂志,2003,9(4):281.
    [44]杨向东,曹吉勋.功能性出口梗阻性便秘的研究进展[J].中国肛肠病杂志,1996,16(5):31-33.
    [45]曹吉勋,杨向东,舒洪权.直肠前突引起出口梗阻型便秘的手术治疗(附80例报告)[J].中国肛肠病杂志,2000,20:19-20.
    [46]俞全民,孙爱群.手术治疗直肠前突18例临床体会[J].中国肛肠病杂志.1998,18(1):38.
    [47]丁义江,李柏年,叶辉,等.直肠前突并发直肠脱垂致便秘的临床研究[J].中国肛肠病杂志,1996,16(5):9.
    [48]周德宽,王立萍,张积书等.直肠前突外科治疗64例体会[J].中国肛肠病杂志,1993,(5):24.
    [49]赵演顺,赵宇.直肠前壁修补加行肛管侧切术治疗直肠前突[J].中国胃肠外科杂志,2000,3(3):162.
    [50]王建民.经阴道褥式缝扎治疗直肠前突80例[J].中国肛肠病杂志,1999,19(1):29.
    [51]李云峰.经阴道修补术治疗直肠前突[J].中国肛肠病杂志,1998,18(1):45.
    [52]Fox SD, Stanton SL, Vanh prolapse and rectocele:assessment of repair using Sacracolpopexy with mesh interposition [J]. BJOG.2000,107:1371-1375.
    [53]贺平,唐学贵.硬化注射治疗直肠前突116例临床观察[J].中国肛肠病杂志,2002,22(1):17.
    [54]J Maria G, Brisinda G, Bentivoglio Ar, et al. Antefior rectoeele due to obstructeddefecation relived by bottdinum toxin [J]. Surgery,2001,129:524-529.
    [55]贺平,曹吉勋等.PPH治疗直肠前突的临床运用及相关技术探讨[J].大肠肛门病外科杂志2003,9(增刊):42-43.
    [56]D'Avolio M, Ferrara A, Chimenti C. Transanal rectocele repair using EndoGIA:short-term results of a prospective study[J]. TechColoproctol,2005,9(2):108-114.
    [57]Boccasanta P, Venturi M, Salamina G, et al. New trends in the surgical treatment of outlet obstruction:clinical and functional results of two novel transanal stapled techniques from a randomised controlled trial,2004,19:359-369
    [58]Gagliardi G,Pescatori M, Altomare DF, et al. Results, outcome pre-dictors. and complications after stapled transanal rectal resection for obstructed defecation. Dis Colon Rectum,2008,51:186-195
    [59]尹淑慧,赵克,候庆香,丁健华.吻合器经肛直肠切除术与经阴道手术治疗直肠前突的比较.中国普外基础与临床杂志,2010,17(2):129-132
    [60]王丽峰.STARR手术在直肠前突治疗中的应用.社区医学杂志,2010,8(13):33-34
    [61]唐清珠,子树明,顾成义,罗吉孔,唐世佳,崔龙.STARR手术治疗出口梗阻型便秘214例的临床分析.中华普外科手术学杂志(电子版),2010,4(3):34-37
    [62]汤献忠,李兴谦,杨清,王丹.STARR手术治疗排便障碍综合征的临床疗效观察.结直肠肛门外科,2010,16(4):217-219
    [63]林友彬,杨中权.STARR手术在直肠前突治疗中的应用.结直肠肛门外科,2009,15(3):165-166
    [64]贺平.改良STARR手术治疗直肠前突25例临床观察.结直肠肛门外科杂志.2010,16(6):344-346.
    [65]林友彬,杨中权.STARR手术在直肠前突治疗中的应用[J].结直肠肛门外科杂志.2009,15(3):165-166.
    [66]宫红彦等.3种术式治疗直肠前突的疗效对比观察[J].结直肠肛门外科杂志.2008,14(5):330-332.
    [67]J Sarles JC, Amand A. Selemef, et al. Endorectal)airof rectoeele 1J J. Int J Colorectal Dis,1989,4:167-171.
    [68]喻德洪.现代肛肠外科学[M].北京:人民军医出版社,1997:478.

© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号

地址:北京市海淀区学院路29号 邮编:100083

电话:办公室:(+86 10)66554848;文献借阅、咨询服务、科技查新:66554700