摘要
目的观察经会阴直肠、乙状结肠部分切除术(Altemeier术)联合肛门紧缩术治疗Ⅲ度直肠脱垂的临床疗效。方法12例Ⅲ度直肠脱垂患者采用Altemeier术联合肛门紧缩术治疗,观察患者手术治愈率、术后并发症、术后复发率、术后恢复时间、手术时间、术中出血量、肛门功能改善情况,对治疗效果进行综合评价。结果12例患者均顺利完成手术,均一期愈合,无围手术期死亡病例发生。痊愈11例,好转1例,治愈率91.66%。术中出血量50~120 mL,手术时间70~130 min,住院时间7~12 d。术后患者出现继发性出血0例、便秘2例、肛门疼痛4例、排便习惯改变3例。术后6月回访,12例患者Wexner失禁评分由术前(10.3±3.3)分降至术后(3.7±2.4)分,差异有统计学意义(P<0.05);肛管静息压(ARP)及肛管最大收缩压(AMCP)分别由术前(2.00±0.56)kPa、(4.50±1.16)kPa升至术后(8.50±2.25)kPa、(18.60±2.50)kPa,差异有统计学意义(P<0.05)。结论Altemeier术联合肛门紧缩术治疗Ⅲ度直肠脱垂效果显著,安全性高,并发症少,术后恢复时间短,可显著改善肛门功能,具有较高的临床应用价值。
Objectives To observe the clinical effect of the perineal rectosigmoidectomy(Altermeier procedure)combined with anal constriction in the treatment of gradeⅢrectal prolapse.Methods In this study,12 patients with gradeⅢrectal prolapse were treated with Altemeier procedure combined with anal constriction.The cure rate,complications,recurrence rate,recovery time,operation time,intraoperative bleeding volume and improvement of anal function were observed.Results All the operation completed successfully,primary healing happened to all the cases and no perioperative death occurred.Eleven cases were cured and one case was improved.The cure rate was 91.66%,the intraoperative bleeding volume was 50-120 ml,the operation time was70-130 minutes,and the length of hospital stay was 7-12 days.Postoperative complications included:bleeding in 0 case,constipation in 2 cases,anal pain in 4 cases,and changes in defecation habits in 3 cases.At the follow-up six months after the operation,Wexner incontinence score of 12 patients significantly decreased from preoperative(10.3±3.3)to postoperative(3.7±2.4)(P<0.05),and anal resting pressure(ARP)and maximum anal systolic pressure(AMCP)significantly increased from(2.00±0.56)kPa and(4.50±1.16)kPa before the operation to(8.50±2.25)kPa and(18.60±2.50)k Pa after the operation,respectively(P<0.05).Conclusions Altemeier procedure combined with anal constriction is effective,safe,with less complications and shorter recovery time in the treatment of gradeⅢrectal prolapse.It can significantly improve anal function and has high clinical application value.
作者
张衡
刘庆圣
万伟萍
杨旭
ZHANG Heng;LIU Qing-sheng;WAN Wei-ping;YANG Xu(Dept.of Proctology,Kunming Municipal Hospital of Traditional Chinese Medicine,Kunming Yunnan 650500,China)
出处
《昆明医科大学学报》
CAS
2020年第3期112-115,共4页
Journal of Kunming Medical University
基金
昆明市科技局科技保障民生发展计划重点项目(2017-1-S-14616)。
