改良经肛门吻合器直肠部分切除术治疗直肠前突的心理评估与生物动力学分析

发布时间：2018-06-29 08:02

本文选题：直肠前突 + 焦虑抑郁　；参考：《吉林大学》2015年硕士论文

【摘要】：目的：探讨中老年女性直肠前突患者可能的发病机制,为经肛门吻合器直肠部分切除术(改良STARR)治疗直肠前突寻找理论依据。方法：对我院结直肠肛门外科收治的自2014年3月至2015年1月经肛管测压及排粪造影检查确诊为直肠前突的患者64例(术前排粪造影结果提示为Ⅱ度、Ⅲ度),行改良经肛门吻合器直肠部分切除术(改良STARR)并20例健康志愿者作为对照组的临床资料进行回顾性分析。本着知情自愿的原则,对其手术前,术后2周及术后3个月以及对照组均进行ODS评分、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)和肛管测压。术前及术后3个月行排粪造影检测。观察其临床疗效,同时观察其术后并发症,评价其治疗效果及安全性。结果： 1.研究发现,中老年女性直肠前突患者存在一定的焦虑或抑郁倾向的心理障碍,结果显示术前44例患者汉密尔顿抑郁量表(HAMD)评分大于7分,提示存在抑郁性心理障碍。占总人数的68.75%；其中轻度抑郁者38人(86.36%),中度抑郁者6人(13.64%)。58例患者汉密尔顿焦虑量表(HAMA)评分大于14分,提示存在焦虑性心理障碍,占总人数的90.63%；其中轻度焦虑者40人(62.5%)；中度焦虑者18人(28.13%)。病例组各时期评分均显著高于对照组。 2.在心理评估方面,行改良经肛门吻合器直肠部分切除术(改良STARR)治疗后,患者的HAMA及HAMD总分均呈现先降后升的改变。 3.患者治疗后ODS症状评分较治疗前显著降低。术后3个月复查排粪造影,50例患者(14例失访病例)直肠前突及直肠粘膜内脱垂得到明显改善。各组括约肌功能长度的差异无统计学意义(P0.05)：病例组术后2周初始感觉阈值、最大耐受阈值、初始排便阈值均明显低于术前及对照组(P0.05)。术后3个月初始感觉阈值、最大耐受阈值、初始排便阈值显著回升。结论：中老年女性直肠前突患者存在肛门直肠动力学改变以及焦虑、抑郁等心理精神障碍,改良经肛门吻合器直肠部分切除术(改良STARR)手术治疗是行之有效的治疗方案。
[Abstract]:Objective: to explore the possible pathogenesis of rectal protrusion in middle-aged and elderly women, and to find a theoretical basis for the treatment of rectocele by transanal stapler partial resection (STARR). Methods: from March 2014 to January 2015, 64 patients with anorectal protrusion were diagnosed by anal manometry and defecography from March 2014 to January 2015. The clinical data of 20 healthy volunteers as control group and modified transanal stapler partial resection (STARR) were analyzed retrospectively. ODS scores, Hamilton anxiety scale (Hama), Hamilton depression scale (Hamd) and anus manometry were performed before, 2 weeks and 3 months after operation. Defecography was performed before and 3 months after operation. To observe the clinical effect and postoperative complications, to evaluate the efficacy and safety of the treatment. Results: 1. The results showed that 44 patients with rectal protrusion had anxiety or depression tendency. The results showed that the score of Hamilton Depression scale (Hamd) in 44 patients before operation was more than 7, which indicated that there was depressive psychological disorder. Among them, 38 (86.36%) were mild depression, 6 (13.64%) were moderate depression, and the score of Hamilton anxiety scale (Hama) in 58 patients was more than 14, indicating that there was anxiety disorder, accounting for 90.63% of the total, among which 40 (62.5%) were mild anxiety. 18 (28.13%) had moderate anxiety. The scores of each stage in the case group were significantly higher than those in the control group. 2. 2. In psychological evaluation, the total scores of Hama and Hamd decreased first and then increased after modified transanal stapler partial resection (STARR). 3. After treatment, ODS symptom score was significantly lower than that before treatment. The rectal protrusion and rectal intramucosal prolapse were significantly improved in 50 patients with defecography 3 months after operation. There was no significant difference in the functional length of sphincter in each group (P0.05): the initial sensory threshold the maximum tolerance threshold and the initial defecation threshold were significantly lower in the case group than before and in the control group (P0.05). The initial sensory threshold, maximum tolerance threshold and initial defecation threshold increased significantly 3 months after operation. Conclusion: there are anorectal dynamic changes, anxiety, depression and other mental disorders in elderly women with rectal protrusion. Modified partial resection of rectum (STARR) is an effective method.
【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

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