三种术式联合治疗出口梗阻性便秘的效果及并发症分析

摘要

目的 探讨直肠阴道隔无张力疝修补术、经吻合器直肠黏膜环切术及耻骨直肠肌离断(部分切除)术联合治疗出口梗阻性便秘的临床效果.方法 出口梗阻型便秘40例,所有患者均接受三种术式联合治疗,治疗结束后随访6个月,评估患者手术前后排便情况及肛门直肠功能,评价指标包括初始排便阈值、最大排便阈值、肛管静息压、肛管排便压、直肠最大收缩压、最小松弛容积,统计患者围术期并发症发生情况.结果 术后随访6个月,评估患者排便的基本情况患者的出口梗阻情况及便秘情况较术前显著改善,差异有统计学意义(P<0. 01).术后随访期间对肛门直肠压力测定,结果显示初始排便阈值、最大排便阈值、肛管静息压、肛管排便压、最小松弛容积均较术前明显降低,直肠最大收缩压显著升高,差异均有统计学意义(P<0. 05).围术期并发症发生率为27. 5% (11/40),包括切口感染(5. 00% )、切口出血(5. 00% )、切口部分裂开(2. 50% )、急性尿潴留(7. 50% )、肛门失禁(7. 50% ),其中1例切口部分裂开患者进行了再次手术干预.结论 三种术式联合治疗出口梗阻性便秘效果显著,安全性高.%Objective To evaluate the clinical effects of rectovaginal septum tension-free hernia repair combined with PPH and puborectal muscle dissection in treatment of outlet obstructive constipation (OOC). Methods Forty patients with OOC who were treated by surgery in our hospital from November 2015 to January 2018 were enrolled in the study. All the patients received combination treatment of three kinds of operation methods, with 6-month follow up after surgery. The defecation and rectal function before and after operation,with the evaluation indexes including initial defecation threshold, maximum defecation threshold, anal static pressure, anal catheter pressure, rectal maximum systolic pressure, minimum relaxation volume and incidence of perioperative complications were statistically evaluated. Results After 6 - month postoperative follow up,the situation of outlet obstruction and constipation status of patients were significantly improved,as compared with thoes before operation (P<0. 01). Anorectal pressure measurement results during follow up showed that the initial defecation threshold, maximum defecation threshold,static pressure,catheter pressure and minimum relaxation volume were significantly decreased, as compared with those before surgery, however, the maximum rectal systolic pressure was increased significantly (P<0. 05). The incidence of perioperative complications was 27. 5% (11/40),including incisional infection (5. 00% ),incision bleeding (5. 00% ),incision (2. 50% ),acute urinary retention (7. 50% ),and anal incontinence (7. 50% ), in whom, one patient had partial fissuratio in incision after operation, who were treated by surgery again. Conclusion The combination application of rectovaginal septum tension-free hernia repair combined with PPH and puborectal muscle dissection in treatment of OOC can obtain satisfactory therapeutic effects,with good safety.