两种改良经肛吻合器直肠切除术在直肠前突中的应用

发布时间：2018-07-06 15:16

本文选题：经肛吻合器直肠切除 + 直肠前突　；参考：《蚌埠医学院》2017年硕士论文

【摘要】：目的:比较和分析治疗直肠前突(rectocele,RC)的三种手术方式,为改良经肛吻合器直肠切除(stapled transanal rectal resection,STARR)术应用于临床的可行性提供依据。方法:选取2013年5月至2015年11月蚌埠医学院第一附属医院胃肠外科收治的92例直肠前突患者,严格依据纳入标准及排除标准,将符合标准的90例患者纳入研究。90例患者均为女性,按入院时间顺序将其随机分为Ⅰ、Ⅱ、Ⅲ三组。Ⅰ组30例,年龄38~65岁,平均(54.47±6.89)岁;病程1~12年,平均(6.75±2.85)年;排粪造影显示,直肠前突深度1.6~3.0cm者12例,≥3.1cm者18例,平均(4.18±1.35)cm。Ⅱ组30例,年龄41~65岁,平均(54.23±6.84)岁;病程0.5~11年,平均(6.57±2.96)年;排粪造影显示,直肠前突深度1.6~3.0cm者14例,≥3.1cm者16例,平均(4.03±1.36)cm。Ⅲ组30例,年龄42~68岁,平均(54.33±6.98)岁;病程1~13年,平均(6.60±2.91)年;排粪造影显示,直肠前突深度1.6~3.0cm者11例,≥3.1cm者19例,平均(4.27±1.30)cm。三组患者的年龄、病程、直肠前突深度的总体均数无明显差别,差异均无统计学意义(P均0.05),具有可比性。Ⅰ组患者采用STARR术改良术式一,Ⅱ组患者采用STARR术改良术式二,Ⅲ组采用传统STARR术。比较并分析三组患者术前、术后1周、术后12周、术后24周的ODS评分;比较三组患者在临床疗效、手术时间、住院费用、住院时间、术后并发症等方面的差异。结果:分别将三组患者术后1周、术后12周、术后24周的ODS评分与本组患者的术前ODS评分进行比较,结果显示,三组患者术后各随访时间点的ODS评分较术前评分均显著下降,差异均有统计学意义(Ⅰ组:ta=30.540,30.133,36.852,P均=0.000;Ⅱ组:tb=29.509,32.279,42.298,P均=0.000;Ⅲ组:tc=27.112,35.721,40.799,P均=0.000)。分别对三组患者在术前、术后1周、术后12周、术后24周的ODS评分进行组间比较,其差异均无统计学意义(F=0.107,0.094,0.129,0.123;P=0.899,0.910,0.879,0.884)。在临床疗效、住院时间、术后并发症发生率上,三组患者无显著差异(P0.05)。而在手术时间和住院费用上,Ⅰ组患者明显低于Ⅱ组和Ⅲ组,差异有统计学意义(P均0.01)。结论:STARR术改良术式一在治疗直肠前突方面疗效确切、安全可行,还具有手术时间短、手术创伤小、治疗费用低的优势,是治疗直肠前突的良好选择之一。
[Abstract]:Objective: To compare and analyze the three surgical methods for the treatment of rectocele (RC), and to provide a basis for the improvement of the feasibility of the application of stapled transanal rectal resection, STARR (STARR) to the clinical feasibility. Methods: to select 92 cases of the First Affiliated Hospital of Bengbu Medical College from May 2013 to November 2015. The patients with protrusion of the intestine were strictly based on the inclusion criteria and exclusion criteria, and 90 cases of.90 patients were included in the study. They were divided into group I, II, and three groups according to the order of admission. 30 cases in group I, age 38~65 years, average (54.47 + 6.89) years, and the course of 1~12 years (6.75 + 2.85) years; defecography display, the depth of rectum protrusion 12 cases of degree 1.6~3.0cm, 18 cases (4.18 + 1.35) and 30 cases (4.18 + 1.35), mean (54.23 + 6.84) years old, average age (54.23 + 6.84) years, average (6.57 + 2.96) years of course 0.5~11 years, 14 cases, 14 cases of rectal protrusion depth 1.6~3.0cm, 16 cases of 3.1cm, average (4.03 + 1.36) cm. III, average age, 42~68 years, course of illness, 1~1. 3 years, average (6.60 + 2.91) years; defecography showed that 11 cases of rectal protrusion depth 1.6~3.0cm, 19 cases of more than 3.1cm, average (4.27 + 1.30) cm. three patients of age, course of disease, the total number of rectal protrusion depth of no significant difference, the difference was not statistically significant (P 0.05), with comparable. Group I used STARR to improve the operation type, II, II Group patients were modified by STARR operation two, group III using traditional STARR. Compare and analyze the three groups of patients before operation, 1 weeks after operation, 12 weeks after operation, 24 weeks of ODS score, compared the three groups of patients in clinical effect, operation time, hospitalization expenses, hospitalization time, postoperative complications and other differences. Results: three groups of patients after 1 weeks, postoperative, respectively. 12 weeks, the ODS score of 24 weeks after the operation was compared with the preoperative ODS score in this group. The results showed that the ODS scores of the three groups were significantly lower than those before the operation, and the difference was statistically significant (group I: ta=30.540,30.133,36.852, P =0.000; group II: tb=29.509,32.279,42.298, P all =0.000; group III: tc=27.112,35.. 721,40.799, P =0.000). The differences were not statistically significant (F=0.107,0.094,0.129,0.123; P=0.899,0.910,0.879,0.884) between the three groups before operation, 1 weeks after operation, 12 weeks after operation and 24 weeks after operation (F=0.107,0.094,0.129,0.123; P=0.899,0.910,0.879,0.884). There was no significant difference between the three groups in the clinical effect, the time of hospitalization and the incidence of postoperative complications (P0.05). In operation time and hospitalization cost, group I was significantly lower than group II and group III, the difference was statistically significant (P 0.01). Conclusion: STARR is effective, safe and feasible in the treatment of rectum protrusion, and has the advantages of short operation time, small surgical trauma and low treatment cost. It is a good choice for the treatment of rectum protrusion. 1.
【学位授予单位】：蚌埠医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R657.1

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