Application of modified procedure for prolapse and hemorrhoids combined with pagoda suture by anorectal mucosa in patients with rectocele

doi:10.3877/cma.j.issn.1674-0793.2018.03.007

Abstract

Abstract:

Objective

To explore the curative effect of modified procedure for prolapse and hemorrhoids (PPH) combined with pagoda suture by anorectal mucosa in the treatment of rectocele.

Methods

From May 2013 to August 2017, sixty female patients with rectocele diagnosed and treated in Handan Central Hospital and Handan Third Hospital were randomly divided into two groups, with 30 cases in each group. The trial group was treated with modified PPH combined with pagoda suture of rectal mucosa, and the control group was only treated with pagoda suture through anorectal mucosa. The improvement of constipation in patients was observed and the difference of treatment effect and Longo ODS score were compared between the two groups.

Results

The postoperative constipation condition of both groups had certain improvement, and the curative effect within 1 month after operation and Longo ODS score had no statistical significance. The curative effect of the trial group 3 months after operation was significantly better than that of the control group (Uc=10.469, P<0.05), Longo ODS score was significantly lower than the control group, the difference was statistically significant (5.23±1.56 vs 7.35±2.23, t=4.267, P<0.05). There was no recurrence in the trial group, and 5 cases (16.7%) in the control group during the follow-up, with no significant difference in recurrence between the two groups (χ²=3.491, P=0.062). The complication rate of the trial group was 13.3% (4/30), which was significantly lower than that of the control group (53.3%, 16/30), with statistically significant difference (χ²=10.800, P=0.001).

Conclusion

Modified PPH combined with pagoda suture by anorectal mucosa has more advantages and can be used to treat outlet obstructive constipation.

Key words: Rectocele, Constipation, Proeedure for prolapse and hemorrhoids, Pagoda suture by anorectal mucosa

Weihong Zhao, Yunzhang Feng, Baofang Lyu, Hua Li, Weidong Wang, Minghai Guo, Xiaowei Wu. Application of modified procedure for prolapse and hemorrhoids combined with pagoda suture by anorectal mucosa in patients with rectocele[J]. Chinese Archives of General Surgery(Electronic Edition), 2018, 12(03): 180-183.

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References 18

[1]	熊万成，贺德栋，郑巍巍, 等. 吻合器痔上黏膜环切术与经阴道直肠前壁修补术、肛管松解术联合应用治疗直肠前突43例[J]. 山东医药, 2016, 56(31): 85-87.
[2]	Menconi C, Fabiani B, Giani I, et al. Persistent anal and pelvic floor pain after PPH and STARR: surgical management of the fixed scar staple line[J]. Int J Colorectal Dis, 2016, 31(1): 41-44.
[3]	黄梅，贾雄，任叔阳, 等. PPH术联合穴位注射在直肠前突型便秘治疗中的临床疗效[J]. 世界中西医结合杂志, 2016, 11(8): 1126-1129.
[4]	高杨. 直肠前突修补联合PPH术对直肠前突患者预后的改善作用[J]. 结直肠肛门外科, 2017, 23(1): 9-12.
[5]	车宪文，张燕红，郑华军. PPH加Block术与单纯Block术治疗直肠前突的临床比较研究[J]. 浙江医学, 2015, 37(4): 311-313.
[6]	Abbott R, Ayres I, Hui E, et al. Effect of perineal self-acupressure on constipation: a randomized controlled trial[J]. J Gen Intern Med, 2015, 30(4): 434-439.
[7]	刘进中，马莉. 吻合器痔环切术联合直肠前突修补对直肠前突的疗效[J]. 长春中医药大学学报, 2016, 32(1): 174-175, 178.
[8]	张忠伟，刘扬，路明. 痔上黏膜环切术治疗直肠前突所致出口梗阻型便秘的疗效观察[J]. 临床外科杂志, 2016, 24(10): 774-776.
[9]	席锋祥，王常生. 穴位注射配合吻合器痔上黏膜环切术治疗直肠前突[J]. 吉林中医药, 2015, 35(2): 198-200.
[10]	王留珍，王章生，刘浏荣, 等. 经阴道入路结合PPH手术与单纯PPH手术治疗直肠前突近远期的疗效观察[J]. 湖南中医药大学学报, 2016, 4(2): 929.
[11]	Bozkurt MA, Kocataş A, Karabulut M, et al. Two etiological reasons of constipation: anterior rectocele and internal mucosal intussusception[J]. Indian J Surg, 2015, 77(Suppl 3): 868-871.
[12]	贺平，陈宏亮. 吻合器痔上黏膜环切钉合术与Milligan-Morgan术治疗脱垂性痔的Meta分析[J]. 中华胃肠外科杂志, 2015, 18(12): 1224-1230.
[13]	魏多刚，任晓华，李正, 等. 吻合器痔上黏膜环切术联合直肠前壁修补治疗直肠前突的临床疗效[J]. 中日友好医院学报, 2016, 30(6): 342-344.
[14]	Luo J, Chen L, Fenner DE, et al. A multi-compartment 3-D finite element model of rectocele and its interaction with cystocele[J]. J Biomech, 2015, 48(9): 1580-1586.
[15]	Podzemny V, Pescatori LC, Pescatori M. Management of obstructed defecation[J]. World J Gastroenterol, 2015, 21(4): 1053-1060.
[16]	Shafik AA, El SO, Shafik IA. Rectocele repair with stapled transvaginal rectal resection[J]. Tech Coloproctol, 2016, 20(4): 207-214.
[17]	吴延德. 直肠黏膜多点结扎加吻合器痔上黏膜环切术治疗女性直肠前突合并直肠黏膜内脱垂(附40例报告)[J]. 外科理论与实践, 2016, 21(6): 535-536.
[18]	刘智勇，杨关根，邓群, 等. 部分吻合器经肛门直肠切除术联合Bresler术治疗直肠前突合并直肠内套叠疗效观察[J]. 中华胃肠外科杂志, 2016, 19(5): 566-570.

组别	例数	年龄（岁, ±s）	平均病程（年, ±s）	LongoODS评分（分）			排粪造影(mm)
组别	例数	年龄（岁, ±s）	平均病程（年, ±s）	8~12	>12~18	>18	16~30	>30
试验组	30	36.5±9.4	7.38±2.3	4	16	10	14	16
对照组	30	35.2±8.7	7.19±2.4	5	14	11	13	17
统计值		t=2.266	t=0.313	χ²=0.159			χ²=0.067
P值		>0.05	>0.05	>0.05			>0.05

组别	例数	年龄（岁, ±s）	平均病程（年, ±s）	LongoODS评分（分）			排粪造影(mm)
组别	例数	年龄（岁, ±s）	平均病程（年, ±s）	8~12	>12~18	>18	16~30	>30
试验组	30	36.5±9.4	7.38±2.3	4	16	10	14	16
对照组	30	35.2±8.7	7.19±2.4	5	14	11	13	17
统计值		t=2.266	t=0.313	χ²=0.159			χ²=0.067
P值		>0.05	>0.05	>0.05			>0.05

组别	术后第1次			术后第1周			术后1个月			术后3个月
组别	通畅	较通畅	困难	通畅	较通畅	困难	通畅	较通畅	困难	通畅	较通畅	困难
试验组（30例）	29	1	0	29	1	0	28	2	0	25	5	0
对照组（30例）	28	2	0	29	1	0	27	2	1	13	11	6
Uc值	0.568			1.028			0.478			10.469
P值	>0.05			>0.05			>0.05			<0.05

组别	术后第1次			术后第1周			术后1个月			术后3个月
组别	通畅	较通畅	困难	通畅	较通畅	困难	通畅	较通畅	困难	通畅	较通畅	困难
试验组（30例）	29	1	0	29	1	0	28	2	0	25	5	0
对照组（30例）	28	2	0	29	1	0	27	2	1	13	11	6
Uc值	0.568			1.028			0.478			10.469
P值	>0.05			>0.05			>0.05			<0.05

组别	术前	术后1个月	术后3个月	F值^a	P值^a
试验组（30例）	14.23±2.13	4.23±1.68	5.23±1.56	5.125	<0.05
对照组（30例）	14.45±1.98	4.56±1.56	7.35±2.23	3.231	<0.05
t值^b	0.414	0.788	4.267
P值^b	>0.05	>0.05	<0.01

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