直肠前突经阴道后壁切开修补术治疗重度直肠前突的临床观察

发布时间：2018-01-20 03:10

本文关键词： 阴道后壁切开修补手术治疗直肠前突临床观察　出处：《河北医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:通过对采用不同手术方式治疗重度直肠前突的患者,在有效率、术后并发症、手术及住院时间、住院费用、症状评分,以及近、远期疗效方面的比较,来观察和评价经阴道后壁切开修补术治疗重度直肠前突的临床疗效。方法:将90例符合纳入标准的重度直肠前突患者,按随机数字表随机分成A、B、C三组,每组30例。经统计学检验,三组在年龄、病程、直肠前突深度方面,P0.05,差异无统计学意义。A组为观察组,采用经阴道后壁切开修补术,B、C组为对照组,B组采用经直肠闭式修补术(柱状缝扎),C组采用吻合器技术(STARR术),观察分析三组的治疗效果,主要从总体有效率、术后并发症(术后出血、术后疼痛、术后坠胀、术后感染),手术、住院时间、住院费用、症状评分(手术前、术后6周、术后1年)以及近期疗效(术后6周)、远期疗效(术后1年)方面进行观察评估比较。结果:1三组总体有效率比较(术后6周)A组:临床痊愈19例,显效6例,有效3例,无效2例,总有效率93.3%;B组:临床痊愈18例,显效6例,有效3例,无效3例,总有效率90.0%;C组:临床痊愈18例,显效5例,有效4例,无效3例,总有效率90.0%。三组比较,P0.05,无显著性差异。2三组术后并发症情况比较术后出血:A组0例,B组0例,C组2例;术后疼痛:A组2例,B组3例,C组4例;术后肛内坠胀:A组0例,B组7例,C组8例;术后感染:三组均为0例。A组与B、C组比较,P0.05,有显著性差异。B、C组在术后坠胀方面与A组比较,P0.05,有显著性差异,在其它方面与A组比较,P0.05,无显著性差异。3三组手术时间、住院时间、住院费用比较手术时间:A组为46.37±6.73分钟;B组为18.21±4.51分钟;C组为19.36±2.46分钟。住院时间:A组为14.37±3.14天;B组为9.37±4.19天;C组为10.62±3.72天。住院费用:A组为9641.79±430.38元;B组为8309.3±503.72元;C组为13542.91±692.82元。A、B、C三组两两比较,P0.05,有显著性差异。4三组手术前后症状评分比较三组症状评分:A组:术前为13.21±2.07,术后6周为4.32±1.53,术后1年为4.30±1.57;B组:术前为13.52±1.98,术后6周为4.69±1.84,术后1年为6.41±1.73;C组:术前为13.51±1.44,术后6周为4.58±1.76,术后1年为6.67±1.25。组间比较:术前三组比较,P0.05,无显著性差异。术后6周三组比较,P0.05,无显著性差异。术后1年B、C组分别与A组比较,P0.05,有显著性差异。组内比较:A、B、C三组术后6周、术后1年症状评分均与治疗前比较,P值均0.05,有显著性差异。A组术后6周与术后1年比较,P0.05,无显著性差异;B、C组术后6周与术后1年比较,P0.05,有显著性差异。5三组术后6周近期疗效比较三组术后6周症状评分组间比较,P0.05,无显著性差异。6三组术后1年远期疗效比较术后1年B、C两组与A组比较,P0.05,有显著性差异。结论:直肠前突经阴道后壁切开修补术可有效改善患者直肠前突的症状,较经直肠术式术后并发症发生率低,具有操作简便、安全,费用较低廉等优点,减轻了患者的痛苦和经济负担,而且术后患者近远期疗效好,复发率低,值得临床进一步推广应用。
[Abstract]:Objective: to compare the effective rate, postoperative complications, operation and hospitalization time, hospitalization cost, symptom score, and short-term and long-term results of patients with severe rectal protrusion treated by different surgical methods. To observe and evaluate the clinical effect of transvaginal posterior wall incision and repair for severe anterior rectum protrusion. Methods: 90 patients with severe anterior rectal protrusion were randomly divided into two groups according to random digital table. Group C, 30 cases in each group. After statistical test, the three groups in age, course of disease, depth of rectal protrusion P0.05, the difference was not statistically significant. Group A as the observation group, using transvaginal posterior wall incision repair. Group B was treated with closed transrectal repair (group C was treated with stapler technique). Postoperative complications (postoperative bleeding, postoperative pain, postoperative bloating, postoperative infection, operation, length of stay, hospitalization cost, symptom score (preoperation, 6 weeks after operation). One year after operation and one year after operation, the short-term curative effect (6 weeks after operation) and long-term effect (1 year after operation) were observed and compared. Results the total effective rate of group 1 was compared with that of group A (group A: 19 cases were cured clinically at 6 weeks after operation). There were 6 cases of remarkable effect, 3 cases of effective and 2 cases of ineffective. The total effective rate was 93.3%. Group B: clinical recovery 18 cases, remarkable effect 6 cases, effective 3 cases, ineffective 3 cases, total effective rate 90.0%; Group C: clinical recovery in 18 cases, remarkable effect in 5 cases, effective in 4 cases, ineffective in 3 cases, the total effective rate was 90.0%. There was no significant difference in postoperative complications among the three groups. 2 cases of postoperative hemorrhage were compared in group B (n = 0), group B (n = 0) and group C (n = 2). Postoperative pain was found in group A (n = 2), group B (n = 3) and group C (n = 4). Postoperative intraanal distension was found in group A (n = 0), group B (n = 7) and group C (n = 8). Postoperative infection: there were 0 cases in group A and P 0.05 in group B, there was significant difference between group A and group A in terms of postoperative bloating, there was significant difference between group A and group A (P 0.05). There was no significant difference in operation time, hospitalization time and hospitalization cost between group A and group A in other aspects (P 0.05). The operative time of group A was 46.37 卤6.73 minutes. Group B: 18.21 卤4.51 minutes; The hospitalization time of group C was 19.36 卤2.46 minutes and that of group A was 14.37 卤3.14 days. Group B was 9.37 卤4.19 days. Group C was 10.62 卤3.72 days, and the cost of hospitalization was 9641.79 卤430.38 yuan. Group B was 8309.3 卤503.72 yuan; Group C was 13542.91 卤692.82 yuan. There was significant difference between the three groups before and after operation. The symptom score of the three groups was 13.21 卤2.07 before operation and 4.32 卤1.53 at 6 weeks after operation. The postoperative 1 year was 4.30 卤1.57; Group B: preoperative 13.52 卤1.98, postoperative 6 weeks 4.69 卤1.84, postoperative 1 year 6.41 卤1.73; Group C: preoperative 13.51 卤1.44, postoperative 6 weeks 4.58 卤1.76, postoperative 1 year 6.67 卤1.25. There was no significant difference between group B and group A. there was no significant difference between group B and group A at 6 days after operation, but there was significant difference between group C and group A at 1 year after operation, and there was a significant difference between group B and group A (P 0.05), and there was significant difference between group B and group A (P 0.05). The scores of symptoms in group C at 6 weeks after operation and 1 year after operation were significantly different from those before treatment (P < 0.05). There was no significant difference between group A and group A at 6 weeks after operation and 1 year after operation (P 0.05). There was significant difference (P 0.05) between six weeks after operation and one year after operation in group B and C, there was significant difference between the three groups in the short-term curative effect at 6 weeks after operation compared with the symptom score at 6 weeks after operation in the three groups (P0.05). There was no significant difference between the three groups after 1 year long term curative effect comparison between group C and group A 1 year after operation compared with group A (P0.05). Conclusion: transvaginal posterior wall incision and repair of rectal protrusion can effectively improve the symptoms of rectal protrusion, and the incidence of complications is lower than that of transrectal surgery. It is simple and safe. The cost is low, the pain and economic burden of the patients are alleviated, and the short-term and long-term curative effect of postoperative patients is good, and the recurrence rate is low, which is worthy of further clinical application.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R657.1

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