直肠前壁全层切闭术治疗出口梗阻型便秘的效果评价
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摘要
目的评价直肠前壁全层切闭术治疗中重度直肠前突所致出口梗阻型便秘的临床疗效。方法选择2009年1月-2015年1月在深圳市中医医院肛肠科行直肠前壁全层切闭术治疗的40例患者为研究对象,患者术后3、6、12、24个月接受随访,以术后平均手术时间、平均住院时间、术中出血量、术后并发症、便秘症状严重程度(SS)评分、生活质量量表评分(PAC-QoL)作为评价指标,对治疗效果进行评价。结果患者平均手术时间26 min(18～40 min),术后平均住院时间4 d(3～5 d),术中平均出血量30 mL(20～45 mL)。患者术后发生大出血1例,肛门坠胀2例,尿潴留2例,肛门轻度失禁3例。与术前患者SS评分[(16.40±3.56)分]比较,患者术后3个月SS评分[(5.30±2.08)分]、术后6个月SS评分[(4.86±1.67)分]、术后12个月SS评分[(4.75±1.56)分]、术后24个月SS评分[(4.65±1.42)分]均降低,差异有统计学意义(P<0.05)。与患者术前PAC-QoL评分[(51.14±9.20)分]比较,患者术后3个月PAC-QoL评分[(16.19±1.87)分]、术后6个月PAC-QoL评分[(16.41±1.64)分]、术后12个月PAC-QoL评分[(16.76±1.46)分]、术后24个月PAC-QoL评分[(15.20±1.44)分]均降低,差异有统计学意义(P<0.05),临床总有效率为90%。结论直肠前壁全层切闭术对直肠前突所致出口梗阻型便秘有较好的治疗效果,术后并发症少,手术方法操作简单,值得临床推广。
Objective To evaluate the clinical effectiveness of anterior resection of the anterior wall full-thickness of the rectum in the treatment of outlet obstructive constipation(ODS) caused by moderate and severe rectocele. Methods A total of 40 patients with ODS caused by moderate and severe rectocele underwent TST in The Shenzhen Municipal TCM Hospital from January 2009 to January 2015 were enrolled. The patients were followed up at the 3 rd, 6 th, 12 th, and 24 th months after operation. Primary outcomes, including operation time, intraoperative blood loss, hospital stay, the score of postoperative complication, symptom severity(SS) score and patient assessment of constipation quality of life(PAC-QOL) questionnaire were collected as an evaluation index to evaluate the therapeutic effect. Results Mean operative time was 26 minutes(range, 18-40 minutes), mean hospitalization was 4.0 days(range, 3-5 days), and intraoperative blood loss was 30 ml(range, 20-45 mL). A total of 8 complications were reported, including major bleeding(n=1), minor fecal incontinence(n=3), uroschesis(n=2), anal tenesmus(n=2). Compared with the preoperative SS score(16.40± 3.56), the postoperative SS score(5.30±2.08), the postoperative SS score(4.86±1.67), the postoperative SS score(4.75±1.56) and the postoperative SS score(4.65±1.42) were all decreased at 3 rd, 6 th, 12 th and 24 th month, respectively, with statistically significant differences(P<0.05). Compared with patients′ preoperative PAC-QOL score(51.14±9.20), patients′ postoperative PAC-QOL score(16.19±1.87), postoperative PAC-QOL score(16.41±1.64), postoperative PAC-QOL score(16.76±1.46), and postoperative PAC-QOL score(15.20±1.44) all decreased at 3 rd, 6 th, 12 th and 24 th month after surgery, with statistically significant difference(P<0.05). The total clinical effective rate was 90%. Conclusion Anterior resection of the anterior wall full-thickness of the rectum has a better therapeutic effect on outlet obstructive constipation caused by rectocele, with fewer complications and simple operation, which is worthy of clinical promotion.
Objective To evaluate the clinical effectiveness of anterior resection of the anterior wall full-thickness of the rectum in the treatment of outlet obstructive constipation(ODS) caused by moderate and severe rectocele. Methods A total of 40 patients with ODS caused by moderate and severe rectocele underwent TST in The Shenzhen Municipal TCM Hospital from January 2009 to January 2015 were enrolled. The patients were followed up at the 3 rd, 6 th, 12 th, and 24 th months after operation. Primary outcomes, including operation time, intraoperative blood loss, hospital stay, the score of postoperative complication, symptom severity(SS) score and patient assessment of constipation quality of life(PAC-QOL) questionnaire were collected as an evaluation index to evaluate the therapeutic effect. Results Mean operative time was 26 minutes(range, 18-40 minutes), mean hospitalization was 4.0 days(range, 3-5 days), and intraoperative blood loss was 30 ml(range, 20-45 mL). A total of 8 complications were reported, including major bleeding(n=1), minor fecal incontinence(n=3), uroschesis(n=2), anal tenesmus(n=2). Compared with the preoperative SS score(16.40± 3.56), the postoperative SS score(5.30±2.08), the postoperative SS score(4.86±1.67), the postoperative SS score(4.75±1.56) and the postoperative SS score(4.65±1.42) were all decreased at 3 rd, 6 th, 12 th and 24 th month, respectively, with statistically significant differences(P<0.05). Compared with patients′ preoperative PAC-QOL score(51.14±9.20), patients′ postoperative PAC-QOL score(16.19±1.87), postoperative PAC-QOL score(16.41±1.64), postoperative PAC-QOL score(16.76±1.46), and postoperative PAC-QOL score(15.20±1.44) all decreased at 3 rd, 6 th, 12 th and 24 th month after surgery, with statistically significant difference(P<0.05). The total clinical effective rate was 90%. Conclusion Anterior resection of the anterior wall full-thickness of the rectum has a better therapeutic effect on outlet obstructive constipation caused by rectocele, with fewer complications and simple operation, which is worthy of clinical promotion.
引文
[1] 中华医学会外科学分会结直肠肛门外科学组.便秘外科诊治专家共识[J].中华胃肠外科杂志,2010,13(7):546-547.
[2] MURTHY V K,DRKIN B A,SMITH L E,et a1.Excellent outcome using selective criteria for rectocele repair[J].Dis Colon Rectum,1996,39(2):374-377.
[3] 黄穗平.便秘的诊断依据、症候分类、疗效评定[J].辽宁中医药大学学报,2013,30(4):15,210-216.
[4] 金洵,丁义江,丁曙晴,等.便秘患者生存质量自评量表 PAC-QOL 中文版的信度效度及反应度[J]. 世界华人消化杂志,2011,19(2) : 209-213.
[5] 中华医学会消化病学分会胃肠动力学组,中华医学会外科分会结直肠肛门外科学组.中国慢性便秘诊治指南(2013版)[J].胃肠病学,2013,18(10):605-612.
[6] ANDROMANAKOS N,SKANDALAKIS P,TROUPIS T,et a1.Constipation of anorectal outlet obstruction:pathophysiofogy,evaluation and management[J]. Gastroenterol Hepatol,2006,21(4):638-646.
[7] ISBERT C,REIBETANZ J,JAYNE D G,et a1.Comparative study of contourtranstar and STARR procedure for the treatment of obstructed defecation syndrome(ODS)- feasibility morbidity and early functional results[J].Colorectal Dis,2010,12(9):901-908.
[8] 傅传刚,王建平,王斌.结直肠外科学[M].上海:上海科学技术出版社,2016:570.
[9] VITTORIO P,MARCO P,MATTIA B,et a1.Clinical study postoperative MR defecography following failed STARR procedure for obstructive defecative syndrome:A three-centre experience [J].Gastroenterol Res Prac,2017,28(10):783-793.
[10] BRUSEIANO L, LIMONGELLI P, DELGENIO G, et al. Short-term outcomes afterrehabilitation treatment in patients selected by a novel rehabilitation score system (Bruseiano score)with or without previous stapled transanal rectal resection (STARR)for rectal outlet obstruction[J].Int J Colorectal Dis,2013,28(6):783-793.
[11] 郑毅,崔金杰,杨新庆,等.吻合器经肛直肠切除术与经直肠闭式修补术治疗RC的对照研究[J].腹部外科杂志,2014,27(1):47-50.
[12] 于永红,张斌,丁健华,等. 经肛吻合器直肠切除术治疗出口梗阻型便秘的远期疗效[J]. 中华胃肠外科杂志,2017,20(12):1360-1363.
[13] PESCATORI M, ZBRA A P. Reinterventions after complicated or failed STARR procedure[J].Int J Colorectal Dis,2009,24(1):87-95.
[14] 赵守和,常永春.痔上黏膜切除钉合术加直肠前壁修补术治疗直肠前突56例体会[J].临床外科杂志,2014,22(4):254-259.
[15] 张静茹,廖颖婴,魏志军,等.直肠前壁全层切闭术联合升降白术散治疗直肠前突型便秘的疗效分析[J].中国中西医结合消化杂志,2018,26(2):172-177.
[2] MURTHY V K,DRKIN B A,SMITH L E,et a1.Excellent outcome using selective criteria for rectocele repair[J].Dis Colon Rectum,1996,39(2):374-377.
[3] 黄穗平.便秘的诊断依据、症候分类、疗效评定[J].辽宁中医药大学学报,2013,30(4):15,210-216.
[4] 金洵,丁义江,丁曙晴,等.便秘患者生存质量自评量表 PAC-QOL 中文版的信度效度及反应度[J]. 世界华人消化杂志,2011,19(2) : 209-213.
[5] 中华医学会消化病学分会胃肠动力学组,中华医学会外科分会结直肠肛门外科学组.中国慢性便秘诊治指南(2013版)[J].胃肠病学,2013,18(10):605-612.
[6] ANDROMANAKOS N,SKANDALAKIS P,TROUPIS T,et a1.Constipation of anorectal outlet obstruction:pathophysiofogy,evaluation and management[J]. Gastroenterol Hepatol,2006,21(4):638-646.
[7] ISBERT C,REIBETANZ J,JAYNE D G,et a1.Comparative study of contourtranstar and STARR procedure for the treatment of obstructed defecation syndrome(ODS)- feasibility morbidity and early functional results[J].Colorectal Dis,2010,12(9):901-908.
[8] 傅传刚,王建平,王斌.结直肠外科学[M].上海:上海科学技术出版社,2016:570.
[9] VITTORIO P,MARCO P,MATTIA B,et a1.Clinical study postoperative MR defecography following failed STARR procedure for obstructive defecative syndrome:A three-centre experience [J].Gastroenterol Res Prac,2017,28(10):783-793.
[10] BRUSEIANO L, LIMONGELLI P, DELGENIO G, et al. Short-term outcomes afterrehabilitation treatment in patients selected by a novel rehabilitation score system (Bruseiano score)with or without previous stapled transanal rectal resection (STARR)for rectal outlet obstruction[J].Int J Colorectal Dis,2013,28(6):783-793.
[11] 郑毅,崔金杰,杨新庆,等.吻合器经肛直肠切除术与经直肠闭式修补术治疗RC的对照研究[J].腹部外科杂志,2014,27(1):47-50.
[12] 于永红,张斌,丁健华,等. 经肛吻合器直肠切除术治疗出口梗阻型便秘的远期疗效[J]. 中华胃肠外科杂志,2017,20(12):1360-1363.
[13] PESCATORI M, ZBRA A P. Reinterventions after complicated or failed STARR procedure[J].Int J Colorectal Dis,2009,24(1):87-95.
[14] 赵守和,常永春.痔上黏膜切除钉合术加直肠前壁修补术治疗直肠前突56例体会[J].临床外科杂志,2014,22(4):254-259.
[15] 张静茹,廖颖婴,魏志军,等.直肠前壁全层切闭术联合升降白术散治疗直肠前突型便秘的疗效分析[J].中国中西医结合消化杂志,2018,26(2):172-177.