• 1. 中國醫(yī)科大學(xué)附屬第四醫(yī)院肛腸科( 遼寧沈陽 110032);;
  • 2. 中國醫(yī)科大學(xué)附屬第四醫(yī)院綜合外科( 遼寧沈陽 110005);

目的 　比較經(jīng)肛吻合器直腸黏膜環(huán)形切除術(shù)（procedure for prolapse and hemorrhoids，PPH）與經(jīng)直腸閉式修補(bǔ)術(shù)（Block）治療直腸前突的臨床療效。
方法 　對2008年9月至2010年9月期間我院手術(shù)治療的62例直腸前突患者的臨床資料進(jìn)行回顧性分析，根據(jù)手術(shù)方式的不同分為PPH組（n=32）和Block組（n=30）。對2組患者手術(shù)后癥狀改善情況進(jìn)行Longo’s 出口梗阻型便秘（ODS）評分，并對手術(shù)時間、術(shù)中出血量、術(shù)后疼痛評分、需用止痛藥次數(shù)、術(shù)后并發(fā)癥、住院時間及住院費(fèi)用進(jìn)行比較。
結(jié)果 　2組患者術(shù)后排便困難癥狀均有明顯改善。Longo’s ODS評分PPH組術(shù)后1個月與術(shù)后3個月比較，差異無統(tǒng)計(jì)學(xué)意義（P＞0.05），Block組術(shù)后3個月明顯高于術(shù)后1個月（P＜0.01）。2組患者術(shù)后1個月和術(shù)后3個月Longo’s ODS評分、手術(shù)時間、術(shù)中出血量、術(shù)后疼痛評分、需用止痛藥次數(shù)及住院時間方面PPH組均明顯少于Block組（P＜0.01）；但PPH組的治療費(fèi)用明顯多于Block組（P＜0.01）。在PPH組患者中，術(shù)后出現(xiàn)2例輕度肛門失禁，隨訪至術(shù)后3個月時完全恢復(fù)。
結(jié)論 　PPH治療直腸前突與Block一樣安全、有效，從近期療效上看，優(yōu)于Block手術(shù)且復(fù)發(fā)率較低。

引用本文： 袁鹿,郭劍波,林樹森,李春雨. 經(jīng)肛吻合器直腸黏膜切除術(shù)與經(jīng)直腸閉式修補(bǔ)術(shù)治療直腸前突的對比研究. 中國普外基礎(chǔ)與臨床雜志, 2012, 19(2): 151-156. doi: 復(fù)制

1. 尹淑慧，趙克，侯慶香，等．吻合器經(jīng)肛直腸切除術(shù)與經(jīng)陰道手術(shù)治療直腸前突的比較[ J]．中國普外基礎(chǔ)與臨床雜志， 2010，17(2)：129-132．.
2. Dietz H．Rectocele or stool quality：what matters more for symptoms of obstructed defecation?[J]．Tech Coloproctol，2009， 13(4)：265-268．.
3. Renzi A，Izzo D，Di Sarno G，et al．Stapled transanal rectal resection to treat obstructed defecation caused by rectal intussusception and rectocele[J]．Int J Colorectal Dis，2006，21(7)：661667．.
4. Boccasanta P，Venturi M，Stuto A，et al．Stapled transanal rectal resection for outlet obstruction：a prospective，multicenter trial[J]．Dis Colon Rectum，2004，47(8)：1285-1297．.
5. Chen HH，Iroatulam A，Alabaz O，et al．Associations of defecography and physiologic findings in male patients with rectocele[J]．Tech Coloproctol，2001，5(3)：157-161．.
6. Liu J，Zhai LD，Li YS，et al．Measuring the space between vagina and rectum as it relates to rectocele[J]．World J Gastroenterol，2009，15(24)：3051-3054．.
7. Zhang B，Ding JH，Yin SH，et al．Stapled transanal rectal resection for obstructed defecation syndrome associated with rectocele and rectal intussusception[J]．World J Gastroenterol，2010， 16(20)：2542-2548．.
8. Gravié JF，Lehur PA，Huten N，et al．Stapled hemorrhoidopexy versus Milligan-Morgan hemorrhoidectomy：a prospective， randomized，multicenter trial with 2-year ostoperative follow up[J]. Ann Surg，2005，242(1)：29-35．.
9. Grassi R，Romano S，Micera O，et al．Radiographic findings of post-operative double stapled trans anal rectal resection (STARR) in patient with obstructed defecation syndrome (ODS)[J]．Eur J Radiol，2005，53(3)：410-416．.
10. Zimmernlan CW．Posterior vaginal reconstruction using uterosacral colpopexy：the new posterior repairs[C]．Beijing：The first Sino-American meeting of pelvic reconstructive and gynecologic surgeries，2005：196．.
11. Satish SR，Kimberly DW，Leistikow JS．Obstructive defecation：a failure of rectoanal coordination[J]．Am J Gastroenterol， 1998，93(7)：1042-1050．.
12. 吳階平，裘法祖．黃家駟外科學(xué)[ M]．北京：人民衛(wèi)生出版社， 2000：1188-1189．.
13. Mellgren A，Anzén B，Nilsson BY，et al．Results of rectocele repair．A prospective study[J]．Dis Colon Rectum，1995， 38(1)：7-13．.
14. Murthy VK，Orkin BA，Smith LE，et al．Excellent outcome using selective criteria for rectocele repair[J]．Dis Colon Rectum， 1996，39(4)：374-378．.
15. 韓少良，倪士昌．大腸肛門疾病外科治療[ M]．北京：人民軍醫(yī)出版社，2006：487-526．.
16. 喻德洪．現(xiàn)代肛腸外科學(xué)[ M]．北京：人民軍醫(yī)出版社， 1997：477-478．.
17. Block IR．Transrectal repair of rectocele using obliterative suture[J]．Dis Colon Rectum，1986，29(11)：707-711．.
18. van Dam JH，Ginai AZ，Gosselink MJ，et al．Role of defecography in predicting clinical outcome of rectocele repair[J]．Dis Colon Rectum，1997，40(2)：201-207．.
19. de Tayrac R，Picone O，Chauveaud-Lambling A，et al．A 2-year anatomical and functional assessment of transvaginal rectocele repair using a polypropylene mesh[J]．Int Urogynecol J Pelvic Floor Dysfunct，2006，17(2)：100-105．.
20. Yamana T，Takahashi T，Iwadare J．Clinical and physiologic outcomes after transvaginal rectocele repair[J]．Dis Colon Rectum，2006，49(5)：661-667．.
21. Schwandner O，Stuto A，Jayne D，et al．Decision-making algorithm for the STARR procedure in obstructed defecation syndrome：position statement of the group of STARR Pioneers[J]． Surg Innov，2008，15(2)：105-109．.
22. Lenisa L，Schwandner O，Stuto A，et al．STARR with contour transtar：prospective multicentre European study[J]．Colorectal Dis，2009，11(8)：821-827．.
23. Longo A．Treatment of hemorrhoids disease by reduction of mucosa and hemorrhoidal prolapse with a circular stapling device：a new procedure[C]．Rome，Italy：Proceedings of the 6th World Congress of Endoscopic Surgery，1998：777-784．.
24. Laughlan K，Jayne DG，Jackson D，et al．Stapled haemorrhoidopexy compared to Milligan-Morgan and Ferguson haemorrhoidectomy：a systematic review[J]．Int J Colorectal Dis，2009， 24(3)：335-344．.
25. Burch J，Epstein D，Baba-Akbari A，et al．Stapled haemorrhoidectomy (haemorrhoidopexy) for the treatment of haemorrhoids：a systematic review and economic evaluation[J]．Health Technol Assess，2008，12(8)：iii-iv，ix-x，1-193．.
26. Farouk R，Bhardwaj R，Phillips RK．Stapled transanal resection of the rectum (STARR) for the obstructed defaecation syndrome[J]．Ann R Coll Surg Engl，2009，91(4)：287-291．.
27. Regadas FS，Regadas SM，Rodrigues LV，et al．Transanal repair of rectocele and full rectal mucosectomy with one circular stapler：a novel surgical technique[J]．Tech Coloproctol，2005， 9(1)：63-66．.
28. Altomare DF，Rinaldi M，Veglia A，et al．Combined perineal and endorectal repair of rectocele by circular stapler：a novel surgical technique[J]．Dis Colon Rectum，2002，45(11)：15491552．.
29. 梁德森，劉昶，潘尚哈，等．吻合器直腸黏膜環(huán)形切除聯(lián)合經(jīng)直腸閉式修補(bǔ)術(shù)在直腸前突中的應(yīng)用[ J]．中華普通外科雜志， 2004，19(9)：577-578．.
30. Pigot F，Dao-Quang M，Castinel A，et al．Low hemorrhoidopexy staple line does not improve results and increases risk for incontinence[J]．Tech Coloproctol，2006，10(4)：329-333．.
31. Mongardini M，Pappalardo G．The use of Floseal in the prevention and treatment of intra- and post-operative hemorrhage in the surgical treatment of hemorrhoids and colporectocele．Preliminary results[J]．G Chir，2003，24(10）：377-381．.
  1. 1. 尹淑慧，趙克，侯慶香，等．吻合器經(jīng)肛直腸切除術(shù)與經(jīng)陰道手術(shù)治療直腸前突的比較[ J]．中國普外基礎(chǔ)與臨床雜志， 2010，17(2)：129-132．.
  2. 2. Dietz H．Rectocele or stool quality：what matters more for symptoms of obstructed defecation?[J]．Tech Coloproctol，2009， 13(4)：265-268．.
  3. 3. Renzi A，Izzo D，Di Sarno G，et al．Stapled transanal rectal resection to treat obstructed defecation caused by rectal intussusception and rectocele[J]．Int J Colorectal Dis，2006，21(7)：661667．.
  4. 4. Boccasanta P，Venturi M，Stuto A，et al．Stapled transanal rectal resection for outlet obstruction：a prospective，multicenter trial[J]．Dis Colon Rectum，2004，47(8)：1285-1297．.
  5. 5. Chen HH，Iroatulam A，Alabaz O，et al．Associations of defecography and physiologic findings in male patients with rectocele[J]．Tech Coloproctol，2001，5(3)：157-161．.
  6. 6. Liu J，Zhai LD，Li YS，et al．Measuring the space between vagina and rectum as it relates to rectocele[J]．World J Gastroenterol，2009，15(24)：3051-3054．.
  7. 7. Zhang B，Ding JH，Yin SH，et al．Stapled transanal rectal resection for obstructed defecation syndrome associated with rectocele and rectal intussusception[J]．World J Gastroenterol，2010， 16(20)：2542-2548．.
  8. 8. Gravié JF，Lehur PA，Huten N，et al．Stapled hemorrhoidopexy versus Milligan-Morgan hemorrhoidectomy：a prospective， randomized，multicenter trial with 2-year ostoperative follow up[J]. Ann Surg，2005，242(1)：29-35．.
  9. 9. Grassi R，Romano S，Micera O，et al．Radiographic findings of post-operative double stapled trans anal rectal resection (STARR) in patient with obstructed defecation syndrome (ODS)[J]．Eur J Radiol，2005，53(3)：410-416．.
  10. 10. Zimmernlan CW．Posterior vaginal reconstruction using uterosacral colpopexy：the new posterior repairs[C]．Beijing：The first Sino-American meeting of pelvic reconstructive and gynecologic surgeries，2005：196．.
  11. 11. Satish SR，Kimberly DW，Leistikow JS．Obstructive defecation：a failure of rectoanal coordination[J]．Am J Gastroenterol， 1998，93(7)：1042-1050．.
  12. 12. 吳階平，裘法祖．黃家駟外科學(xué)[ M]．北京：人民衛(wèi)生出版社， 2000：1188-1189．.
  13. 13. Mellgren A，Anzén B，Nilsson BY，et al．Results of rectocele repair．A prospective study[J]．Dis Colon Rectum，1995， 38(1)：7-13．.
  14. 14. Murthy VK，Orkin BA，Smith LE，et al．Excellent outcome using selective criteria for rectocele repair[J]．Dis Colon Rectum， 1996，39(4)：374-378．.
  15. 15. 韓少良，倪士昌．大腸肛門疾病外科治療[ M]．北京：人民軍醫(yī)出版社，2006：487-526．.
  16. 16. 喻德洪．現(xiàn)代肛腸外科學(xué)[ M]．北京：人民軍醫(yī)出版社， 1997：477-478．.
  17. 17. Block IR．Transrectal repair of rectocele using obliterative suture[J]．Dis Colon Rectum，1986，29(11)：707-711．.
  18. 18. van Dam JH，Ginai AZ，Gosselink MJ，et al．Role of defecography in predicting clinical outcome of rectocele repair[J]．Dis Colon Rectum，1997，40(2)：201-207．.
  19. 19. de Tayrac R，Picone O，Chauveaud-Lambling A，et al．A 2-year anatomical and functional assessment of transvaginal rectocele repair using a polypropylene mesh[J]．Int Urogynecol J Pelvic Floor Dysfunct，2006，17(2)：100-105．.
  20. 20. Yamana T，Takahashi T，Iwadare J．Clinical and physiologic outcomes after transvaginal rectocele repair[J]．Dis Colon Rectum，2006，49(5)：661-667．.
  21. 21. Schwandner O，Stuto A，Jayne D，et al．Decision-making algorithm for the STARR procedure in obstructed defecation syndrome：position statement of the group of STARR Pioneers[J]． Surg Innov，2008，15(2)：105-109．.
  22. 22. Lenisa L，Schwandner O，Stuto A，et al．STARR with contour transtar：prospective multicentre European study[J]．Colorectal Dis，2009，11(8)：821-827．.
  23. 23. Longo A．Treatment of hemorrhoids disease by reduction of mucosa and hemorrhoidal prolapse with a circular stapling device：a new procedure[C]．Rome，Italy：Proceedings of the 6th World Congress of Endoscopic Surgery，1998：777-784．.
  24. 24. Laughlan K，Jayne DG，Jackson D，et al．Stapled haemorrhoidopexy compared to Milligan-Morgan and Ferguson haemorrhoidectomy：a systematic review[J]．Int J Colorectal Dis，2009， 24(3)：335-344．.
  25. 25. Burch J，Epstein D，Baba-Akbari A，et al．Stapled haemorrhoidectomy (haemorrhoidopexy) for the treatment of haemorrhoids：a systematic review and economic evaluation[J]．Health Technol Assess，2008，12(8)：iii-iv，ix-x，1-193．.
  26. 26. Farouk R，Bhardwaj R，Phillips RK．Stapled transanal resection of the rectum (STARR) for the obstructed defaecation syndrome[J]．Ann R Coll Surg Engl，2009，91(4)：287-291．.
  27. 27. Regadas FS，Regadas SM，Rodrigues LV，et al．Transanal repair of rectocele and full rectal mucosectomy with one circular stapler：a novel surgical technique[J]．Tech Coloproctol，2005， 9(1)：63-66．.
  28. 28. Altomare DF，Rinaldi M，Veglia A，et al．Combined perineal and endorectal repair of rectocele by circular stapler：a novel surgical technique[J]．Dis Colon Rectum，2002，45(11)：15491552．.
  29. 29. 梁德森，劉昶，潘尚哈，等．吻合器直腸黏膜環(huán)形切除聯(lián)合經(jīng)直腸閉式修補(bǔ)術(shù)在直腸前突中的應(yīng)用[ J]．中華普通外科雜志， 2004，19(9)：577-578．.
  30. 30. Pigot F，Dao-Quang M，Castinel A，et al．Low hemorrhoidopexy staple line does not improve results and increases risk for incontinence[J]．Tech Coloproctol，2006，10(4)：329-333．.
  31. 31. Mongardini M，Pappalardo G．The use of Floseal in the prevention and treatment of intra- and post-operative hemorrhage in the surgical treatment of hemorrhoids and colporectocele．Preliminary results[J]．G Chir，2003，24(10）：377-381．.