發(fā)布時(shí)間：2018-01-20 03:10

  本文關(guān)鍵詞： 陰道后壁 切開(kāi)修補(bǔ) 手術(shù)治療 直腸前突 臨床觀察　出處：《河北醫(yī)科大學(xué)》2015年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的:通過(guò)對(duì)采用不同手術(shù)方式治療重度直腸前突的患者,在有效率、術(shù)后并發(fā)癥、手術(shù)及住院時(shí)間、住院費(fèi)用、癥狀評(píng)分,以及近、遠(yuǎn)期療效方面的比較,來(lái)觀察和評(píng)價(jià)經(jīng)陰道后壁切開(kāi)修補(bǔ)術(shù)治療重度直腸前突的臨床療效。方法:將90例符合納入標(biāo)準(zhǔn)的重度直腸前突患者,按隨機(jī)數(shù)字表隨機(jī)分成A、B、C三組,每組30例。經(jīng)統(tǒng)計(jì)學(xué)檢驗(yàn),三組在年齡、病程、直腸前突深度方面,P0.05,差異無(wú)統(tǒng)計(jì)學(xué)意義。A組為觀察組,采用經(jīng)陰道后壁切開(kāi)修補(bǔ)術(shù),B、C組為對(duì)照組,B組采用經(jīng)直腸閉式修補(bǔ)術(shù)(柱狀縫扎),C組采用吻合器技術(shù)(STARR術(shù)),觀察分析三組的治療效果,主要從總體有效率、術(shù)后并發(fā)癥(術(shù)后出血、術(shù)后疼痛、術(shù)后墜脹、術(shù)后感染),手術(shù)、住院時(shí)間、住院費(fèi)用、癥狀評(píng)分(手術(shù)前、術(shù)后6周、術(shù)后1年)以及近期療效(術(shù)后6周)、遠(yuǎn)期療效(術(shù)后1年)方面進(jìn)行觀察評(píng)估比較。結(jié)果:1三組總體有效率比較(術(shù)后6周)A組:臨床痊愈19例,顯效6例,有效3例,無(wú)效2例,總有效率93.3%;B組:臨床痊愈18例,顯效6例,有效3例,無(wú)效3例,總有效率90.0%;C組:臨床痊愈18例,顯效5例,有效4例,無(wú)效3例,總有效率90.0%。三組比較,P0.05,無(wú)顯著性差異。2三組術(shù)后并發(fā)癥情況比較術(shù)后出血:A組0例,B組0例,C組2例;術(shù)后疼痛:A組2例,B組3例,C組4例;術(shù)后肛內(nèi)墜脹:A組0例,B組7例,C組8例;術(shù)后感染:三組均為0例。A組與B、C組比較,P0.05,有顯著性差異。B、C組在術(shù)后墜脹方面與A組比較,P0.05,有顯著性差異,在其它方面與A組比較,P0.05,無(wú)顯著性差異。3三組手術(shù)時(shí)間、住院時(shí)間、住院費(fèi)用比較手術(shù)時(shí)間:A組為46.37±6.73分鐘;B組為18.21±4.51分鐘;C組為19.36±2.46分鐘。住院時(shí)間:A組為14.37±3.14天;B組為9.37±4.19天;C組為10.62±3.72天。住院費(fèi)用:A組為9641.79±430.38元;B組為8309.3±503.72元;C組為13542.91±692.82元。A、B、C三組兩兩比較,P0.05,有顯著性差異。4三組手術(shù)前后癥狀評(píng)分比較三組癥狀評(píng)分:A組:術(shù)前為13.21±2.07,術(shù)后6周為4.32±1.53,術(shù)后1年為4.30±1.57;B組:術(shù)前為13.52±1.98,術(shù)后6周為4.69±1.84,術(shù)后1年為6.41±1.73;C組:術(shù)前為13.51±1.44,術(shù)后6周為4.58±1.76,術(shù)后1年為6.67±1.25。組間比較:術(shù)前三組比較,P0.05,無(wú)顯著性差異。術(shù)后6周三組比較,P0.05,無(wú)顯著性差異。術(shù)后1年B、C組分別與A組比較,P0.05,有顯著性差異。組內(nèi)比較:A、B、C三組術(shù)后6周、術(shù)后1年癥狀評(píng)分均與治療前比較,P值均0.05,有顯著性差異。A組術(shù)后6周與術(shù)后1年比較,P0.05,無(wú)顯著性差異;B、C組術(shù)后6周與術(shù)后1年比較,P0.05,有顯著性差異。5三組術(shù)后6周近期療效比較三組術(shù)后6周癥狀評(píng)分組間比較,P0.05,無(wú)顯著性差異。6三組術(shù)后1年遠(yuǎn)期療效比較術(shù)后1年B、C兩組與A組比較,P0.05,有顯著性差異。結(jié)論:直腸前突經(jīng)陰道后壁切開(kāi)修補(bǔ)術(shù)可有效改善患者直腸前突的癥狀,較經(jīng)直腸術(shù)式術(shù)后并發(fā)癥發(fā)生率低,具有操作簡(jiǎn)便、安全,費(fèi)用較低廉等優(yōu)點(diǎn),減輕了患者的痛苦和經(jīng)濟(jì)負(fù)擔(dān),而且術(shù)后患者近遠(yuǎn)期療效好,復(fù)發(fā)率低,值得臨床進(jìn)一步推廣應(yīng)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 鹵6.73 minutes. Group B: 18.21 鹵4.51 minutes; The hospitalization time of group C was 19.36 鹵2.46 minutes and that of group A was 14.37 鹵3.14 days. Group B was 9.37 鹵4.19 days. Group C was 10.62 鹵3.72 days, and the cost of hospitalization was 9641.79 鹵430.38 yuan. Group B was 8309.3 鹵503.72 yuan; Group C was 13542.91 鹵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 鹵2.07 before operation and 4.32 鹵1.53 at 6 weeks after operation. The postoperative 1 year was 4.30 鹵1.57; Group B: preoperative 13.52 鹵1.98, postoperative 6 weeks 4.69 鹵1.84, postoperative 1 year 6.41 鹵1.73; Group C: preoperative 13.51 鹵1.44, postoperative 6 weeks 4.58 鹵1.76, postoperative 1 year 6.67 鹵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.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R657.1

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