摘要
目的探讨改良直肠下端黏膜切除术（stapledtransanal rectal resection，STARR）治疗重度直肠前突出口梗阻型便秘的临床效果。方法入选80例直肠前突所致出口梗阻型便秘且住院行手术治疗的患者，随机分为治疗组和对照组，每组40例。治疗组行STARR治疗，对照组行经阴道纵切横缝术修补术治疗。观察两组患者不同治疗方法的临床症状及症状量化评分的差异；记录手术时间、术中出血量、伤口愈合时间，收集术后1、3、6、12个月的Wexner便秘评分；观察患者术后有无出血、疼痛、感染、肛门坠胀、直肠阴道瘘等并发症；比较两组患者的临床疗效。结果治疗组临床总有效率100% （40/40）与对照组90.00% （36/40）比较，差异有统计学意义（χ^2＝0.60，P＝0.027）。两组治疗后7 d临床症状积分[治疗组（3.58±1.61）分、对照组（4.12±1.52）分]及治疗后3个月[治疗组（4.23±2.13）分、对照组（5.33±1.12）分]与同组治疗前[治疗组（13.23±3.08）分、对照组（14.45±3.01）分]相比较差异有统计学意义（P均〈0.01）；治疗组治疗后3个月临床症状量化评分与同期对照组相比，差异有统计学意义（P〈0.01）。治疗组在手术时间（15.65±1.61） min、术中出血量（10.77±5.23） ml、伤口愈合时间（9.28±1.41） d方面，治疗组均优于对照组[（25.89±3.71） min、术中出血量（43.31±8.11） ml、伤口愈合时间（14.87±1.92）d]，差异有统计学意义（t值分别为15.632、14.266、15.518，P均〈0.01）。两组术后1、3、6、12个月Wexner评分均低于同组治疗前，治疗组术后1、3、6、12个月Wexner评分低于对照组组（P〈0.05）。在术后并发症方面相比较，治疗组在术后疼痛、肛门坠胀方面优于对照组（P〈0.05）。结论STARR治疗直肠前突所致出口梗阻型便秘疗效确切，远期效果好。
Objective To evaluate the clinical efficacy stapledtransanal in the treatment of severe rectal obstructive constipation.Methods Eighty patients with rectal obstructive constipation and hospitalized in Tangshan City Hospital of TCM were enrolled in the study and randomly divided into the treatment group and control group, 40 cases in each group.The treatment group was treated with stapledtransanal and the control group was treated with transvaginal repair of longitudinally cut transverse suture operation. The clinical symptoms of two groups were observed and quantified.The operation time, intraoperative blood loss and wound healing time were recorded, Wexner constipation scores were collected at 1, 3, 6 and 12 months after the operation; Postoperative bleeding, pain, infection, anal distention, rectovaginal fistula and other complications were observed.The clinical efficacy of the two groups was compared.Results The total effective rate in the treatment group was 100% （40/40）, which was significantly higher than that in the control group （90.00% （36/40）） （χ^2=0.60, P=0.027）. There were significant differences in the clinical symptom scores of the two groups at 7 days （treatment group（3.58±1.61） points, control group（4.12±1.52）points））and 3 months after treatment（treatment group （4.23±2.13）points, control group （5.33±1.12）points） compared with those before treatment （treatment group （13.23±3.08）points, control group （14.45±3.01） points ） （P〈0.05）; There was a statistically significant difference in clinical symptom quantification score between the treatment group and the control group at 3 months after treatment （P〈0.01）. In the treatment group, the operation time （（15.65±1.61） min）, intraoperative bleeding （（10.77±5.23） ml） and wound healing time （（9.28±1.41）） d were better than those of the control group （（25.89±3.71） min, （43.31±8.11） ml, （14.87±1.92） d） （t=15.632, 14.266, 15.518, P〈0.01）.
作者
刘宇
杜雪峰
张海磊
魏永辉
Liu Yu;Du Xuefeng;Zhang Hailei;Wei Yonghui(Anorectal Department, Tangshan City Hospital of TCM, Tangshan 063000, Chin)
出处
《中国综合临床》
2018年第4期330-334,共5页
Clinical Medicine of China
基金
河北省中医药管理局科研计划课题（2017248）
