改良STARR术治疗直肠前突临床应用研究

发布时间：2018-05-12 03:45

本文选题：直肠前突 + 改良STARR术　；参考：《吉林大学》2015年硕士论文

【摘要】：目的：旨在探讨改良STARR术在治疗直肠前突患者时具有的临床应用效果。方法：选取我院结直肠肛门外科2012年10月到2014年6月期间符合研究标准的173例直肠前突患者，分为治疗组（90例）和对照组（83例），治疗组行改良STARR术，对照组行黏膜肌瓣法（Khubchandani修补法)，进行院内和门诊随访，记录两组术式患者在术后1周（手术时间、术中出血量、术后尿潴留、术后便血发生率、术后肛门明显疼痛时间、术后ODS评分及住院天数）的观察指标和分别评价术后1个月及3个月的临床疗效。进行统计学分析两组术式比较项目之间的差异。结果：选入本临床研究的173例直肠前突患者均分别顺利完成上述两组术式，术后1周院内随访，治疗组（改良STARR术）在手术时间（15.1±2.1min）、术中出血量（10.8±2.5ml）、术后尿潴留发生率（8.9%）、术后便血发生率（13.3%）、术后肛门明显疼痛时间（1.1±0.3d）、术后临床症状改善程度（ODS评分2.2±0.6）及住院天数（6.2±0.7d）等近期观察指标结果较对照组（黏膜肌瓣法-Khubchandani修补法）的手术时间（17.9±2.4min）、术中出血量（19.6±3.1ml）、术后尿潴留发生率（20.5%）、术后便血发生率（27.7%）、术后肛门明显疼痛时间（2.8±0.5d）、术后临床症状改善程度（ODS评分4.1±0.5）及住院天数（7.8±0.6d）等指标结果具有明显优势，P0.05，，具有统计学意义。另外，对两组手术方法术后1个月及3个月进行的临床疗效评价（评价标准参照中华医学会外科学分会肛肠外科学组制定的《便秘诊治暂行标准》）结果如表3.3所示。经统计学分析，治疗组的患者在远期临床疗效评价结果上也较对照组存在明确优势，P0.05，具有统计学差异。结论: 1、本临床研究中的统计学分析结果表明应用改良STARR术治疗直肠前突的临床应用效果优于黏膜肌瓣法（Khubchandani修补法），同时也符合文献报道中关于标准STARR术较其他传统手术方法而言拥有的显著优点，具有疗效好、创伤小、并发症少、恢复快等临床应用优势。 2、与标准STARR术相比，改良STARR术具有新的亮点:①以“一针法”精确定位，对直肠前突定位更准。②仅使用一把PPH吻合器，降低治疗费用，节约医疗资源。③仅需单次的切除与吻合，且切除的深度为超过粘膜下层至肌层而未达直肠壁全层。手术创伤性更小。本临床研究表明改良STARR术治疗直肠前突具有良好的临床应用效果。
[Abstract]:Objective: To explore the clinical effect of modified STARR in the treatment of rectocele.
Methods: 173 cases of rectal protrusion in our hospital from October 2012 to June 2014 were selected and divided into the treatment group (90 cases) and the control group (83 cases). The treatment group was treated with modified STARR, and the control group was treated with mucosal muscle flap (Khubchandani repair). The patients were followed up in the hospital and in the outpatient department, and two groups of surgical patients were recorded in the operation. The following 1 weeks (operation time, intraoperative bleeding volume, postoperative urinary retention, postoperative bleeding rate, postoperative anus pain time, postoperative ODS score and the number of days in hospital) were observed and the clinical efficacy of 1 months and 3 months after operation were evaluated respectively. The differences between the two groups were statistically analyzed.
Results: 173 cases of rectal protrusion in this clinical study were successfully completed the above two groups, 1 weeks after the operation in the hospital. The treatment group (modified STARR) was operated on (15.1 + 2.1min), intraoperative bleeding (10.8 + 2.5ml), postoperative urinary retention (8.9%), postoperative incidence of stool (13.3%), and postoperative anus pain (1.1) The postoperative clinical symptom improvement (ODS score 2.2 + 0.6) and the number of hospitalized days (6.2 + 0.7d) were compared with the control group (17.9 + 2.4min) of the control group (17.9 + 2.4min), intraoperative bleeding (19.6 + 3.1ml), postoperative urinary retention (20.5%), postoperative bleeding rate (27.7%), and postoperative anus obvious Pain time (2.8 + 0.5d), postoperative clinical symptoms improvement (ODS score 4.1 + 0.5) and hospitalization days (7.8 + 0.6d) have obvious advantages, P0.05, with statistical significance. In addition, the evaluation of the clinical efficacy of the two groups of surgical methods 1 months and 3 months after the operation of the Chinese Medical Association outside the science branch anorectal. The results of the provisional standard for the diagnosis and treatment of constipation made by the scientific group were shown in table 3.3. By statistical analysis, the patients in the treatment group had a definite advantage over the control group in the outcome of the long-term clinical efficacy, P0.05, with statistical differences.
Conclusion:
1, the results of statistical analysis in this clinical study show that the clinical application of modified STARR in the treatment of protrusion of rectum is better than that of the mucosal muscle flap (Khubchandani repair). It also conforms to the significant advantages of the standard STARR operation compared with other traditional surgical methods, which have good curative effect, small trauma and fewer complications. Quick recovery and other clinical application advantages.
2, compared with the standard STARR, the improved STARR has a new bright spot: (1) the precise location of the "one needle" method and the more accurate location of the protrusion of the rectum. (2) only one PPH stapler is used only to reduce the cost of treatment and save medical resources. Surgery is less traumatic.
This clinical study shows that modified STARR has good clinical effect in the treatment of rectocele.

【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R657.1

【参考文献】