發(fā)布時間：2018-06-29 08:02

  本文選題：直腸前突 + 焦慮抑郁　； 參考：《吉林大學》2015年碩士論文

【摘要】：目的：探討中老年女性直腸前突患者可能的發(fā)病機制,為經(jīng)肛門吻合器直腸部分切除術(shù)(改良STARR)治療直腸前突尋找理論依據(jù)。 方法：對我院結(jié)直腸肛門外科收治的自2014年3月至2015年1月經(jīng)肛管測壓及排糞造影檢查確診為直腸前突的患者64例(術(shù)前排糞造影結(jié)果提示為Ⅱ度、Ⅲ度),行改良經(jīng)肛門吻合器直腸部分切除術(shù)(改良STARR)并20例健康志愿者作為對照組的臨床資料進行回顧性分析。本著知情自愿的原則,對其手術(shù)前,術(shù)后2周及術(shù)后3個月以及對照組均進行ODS評分、漢密爾頓焦慮量表(HAMA)、漢密爾頓抑郁量表(HAMD)和肛管測壓。術(shù)前及術(shù)后3個月行排糞造影檢測。觀察其臨床療效,同時觀察其術(shù)后并發(fā)癥,評價其治療效果及安全性。 結(jié)果： 1.研究發(fā)現(xiàn),中老年女性直腸前突患者存在一定的焦慮或抑郁傾向的心理障礙,結(jié)果顯示術(shù)前44例患者漢密爾頓抑郁量表(HAMD)評分大于7分,提示存在抑郁性心理障礙。占總?cè)藬?shù)的68.75%；其中輕度抑郁者38人(86.36%),中度抑郁者6人(13.64%)。58例患者漢密爾頓焦慮量表(HAMA)評分大于14分,提示存在焦慮性心理障礙,占總?cè)藬?shù)的90.63%；其中輕度焦慮者40人(62.5%)；中度焦慮者18人(28.13%)。病例組各時期評分均顯著高于對照組。 2.在心理評估方面,行改良經(jīng)肛門吻合器直腸部分切除術(shù)(改良STARR)治療后,患者的HAMA及HAMD總分均呈現(xiàn)先降后升的改變。 3.患者治療后ODS癥狀評分較治療前顯著降低。術(shù)后3個月復查排糞造影,50例患者(14例失訪病例)直腸前突及直腸粘膜內(nèi)脫垂得到明顯改善。各組括約肌功能長度的差異無統(tǒng)計學意義(P0.05)：病例組術(shù)后2周初始感覺閾值、最大耐受閾值、初始排便閾值均明顯低于術(shù)前及對照組(P0.05)。術(shù)后3個月初始感覺閾值、最大耐受閾值、初始排便閾值顯著回升。 結(jié)論：中老年女性直腸前突患者存在肛門直腸動力學改變以及焦慮、抑郁等心理精神障礙,改良經(jīng)肛門吻合器直腸部分切除術(shù)(改良STARR)手術(shù)治療是行之有效的治療方案。
[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.
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R657.1

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本文編號：2081449