两种术式治疗直肠前突的对比研究(1)
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【摘要】目的：探讨“阴道双荷包修补加直肠前壁硬化注射术”治疗直肠前突的临床疗效。方法：将确诊的62例直肠前突病人随机分成试验组和对照组，且两组病例数相等，其中试验组31例采用“阴道双荷包修补加直肠前壁硬化注射术”，对照组31例采用“直肠粘膜间断缝合加硬化剂注射术”。观察比较两组病例的近远期疗效、术中术后出血、术后肛门疼痛及坠胀、术后感染。结果：两组近期疗效、术后出血、术后肛门坠胀、术后感染相比无统计学差异(P>0.05)，术中出血、术后肛门疼痛两组间有统计学差异(P<0.05)，且对照组优于试验组，但试验组的远期疗效优于对照组，有统计学差异(P<0.05)。结论：“阴道双荷包修补加直肠前壁硬化注射术”与“直肠粘膜间断缝合加硬化剂注射术”相比，具有疗效稳定、远期疗效好等优点。
【关键词】直肠前突；阴道双荷包修补加直肠前壁硬化注射术；临床研究
【Abstract】Objective: To observe and evaluate The wall hardened the skill of injecting before one pair of small bags of vagina was mended to add the rectum .Methods: A randomized study was made in 62 patients, the study group(31cases) received the treatment of the wall hardened the skill of injecting before one pair of small bags of vagina was mended to add the rectum , the control group(31cases) with Discontinuous stylolitic suture with sclerosing agent injection. Study the short and long term therapeutic effect, hemorrhage during the operative process and post-operation, sensation of pain and tenesmus in the anus. Results: Postoperative symptomatic scores were lower than those of pro-operation. The short term therapeutic effect、hemorrhage after the operation、sensation of tenesmus、postoperative inflammation in the two groups had no statistic differences(P>0.05).on the contrary， hemorrhage during the operative process、sensation of pain in the anus (P<0.05),and the control group was better. but the long term therapeutic effect of the study group was much better than the control group(P<0.05).Conclusion：The long term therapeutic effect of the study group, to rectocele ,was more stable and utility than the control group .
【Key words】rectocele；the wall hardened the skill of injecting before one pair of small bags of vagina was mended to add the rectum；clinical research
直肠前突的治疗方法有保守治疗与手术治疗。保守治疗主要以药物调理，饮食结构调理以及生物反馈等方式达到缓解症状的目的，适用于轻度患者。由于无症状妇女80%可存在直肠前突[1]，如何判断直肠前突出与便秘之间的关系，直接决定手术治疗的效果。手术治疗主要有经直肠、经阴道、经会阴及经腹四种入路，修补、加固直肠阴道隔。从现有资料分析，手术修补效果是所有便秘手术中最难预料的，30%～72%的患者术后仍有不同程度的排便困难[2]。因而探寻一种安全、有效、简便、远期疗效稳定的治疗方法，具有重要的意义。
1资料与方法
1.1一般资料：62例均为2007年8月~2010年10月在我院住院患者，符合1999年中华医学会外科学分会肛肠外科学组山东会议拟定的《便秘诊断暂行标准》[3]：(1) 症状：排便困难，肛门梗阻感，肛门及会阴部坠胀、疼痛，排便不尽感。用手指插入阴道内按压阴道后壁方能排出粪便，是直肠前突特有的症状。(2) 指检：可触及肛管上端的直肠前壁有一圆形或卵圆形突向阴道的薄弱区 ......
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