本文選題：經(jīng)肛吻合器直腸切除 + 直腸前突　； 參考：《蚌埠醫(yī)學院》2017年碩士論文

【摘要】：目的:比較和分析治療直腸前突(rectocele,RC)的三種手術(shù)方式,為改良經(jīng)肛吻合器直腸切除(stapled transanal rectal resection,STARR)術(shù)應(yīng)用于臨床的可行性提供依據(jù)。方法:選取2013年5月至2015年11月蚌埠醫(yī)學院第一附屬醫(yī)院胃腸外科收治的92例直腸前突患者,嚴格依據(jù)納入標準及排除標準,將符合標準的90例患者納入研究。90例患者均為女性,按入院時間順序?qū)⑵潆S機分為Ⅰ、Ⅱ、Ⅲ三組。Ⅰ組30例,年齡38~65歲,平均(54.47±6.89)歲;病程1~12年,平均(6.75±2.85)年;排糞造影顯示,直腸前突深度1.6~3.0cm者12例,≥3.1cm者18例,平均(4.18±1.35)cm。Ⅱ組30例,年齡41~65歲,平均(54.23±6.84)歲;病程0.5~11年,平均(6.57±2.96)年;排糞造影顯示,直腸前突深度1.6~3.0cm者14例,≥3.1cm者16例,平均(4.03±1.36)cm。Ⅲ組30例,年齡42~68歲,平均(54.33±6.98)歲;病程1~13年,平均(6.60±2.91)年;排糞造影顯示,直腸前突深度1.6~3.0cm者11例,≥3.1cm者19例,平均(4.27±1.30)cm。三組患者的年齡、病程、直腸前突深度的總體均數(shù)無明顯差別,差異均無統(tǒng)計學意義(P均0.05),具有可比性。Ⅰ組患者采用STARR術(shù)改良術(shù)式一,Ⅱ組患者采用STARR術(shù)改良術(shù)式二,Ⅲ組采用傳統(tǒng)STARR術(shù)。比較并分析三組患者術(shù)前、術(shù)后1周、術(shù)后12周、術(shù)后24周的ODS評分;比較三組患者在臨床療效、手術(shù)時間、住院費用、住院時間、術(shù)后并發(fā)癥等方面的差異。結(jié)果:分別將三組患者術(shù)后1周、術(shù)后12周、術(shù)后24周的ODS評分與本組患者的術(shù)前ODS評分進行比較,結(jié)果顯示,三組患者術(shù)后各隨訪時間點的ODS評分較術(shù)前評分均顯著下降,差異均有統(tǒng)計學意義(Ⅰ組:ta=30.540,30.133,36.852,P均=0.000;Ⅱ組:tb=29.509,32.279,42.298,P均=0.000;Ⅲ組:tc=27.112,35.721,40.799,P均=0.000)。分別對三組患者在術(shù)前、術(shù)后1周、術(shù)后12周、術(shù)后24周的ODS評分進行組間比較,其差異均無統(tǒng)計學意義(F=0.107,0.094,0.129,0.123;P=0.899,0.910,0.879,0.884)。在臨床療效、住院時間、術(shù)后并發(fā)癥發(fā)生率上,三組患者無顯著差異(P0.05)。而在手術(shù)時間和住院費用上,Ⅰ組患者明顯低于Ⅱ組和Ⅲ組,差異有統(tǒng)計學意義(P均0.01)。結(jié)論:STARR術(shù)改良術(shù)式一在治療直腸前突方面療效確切、安全可行,還具有手術(shù)時間短、手術(shù)創(chuàng)傷小、治療費用低的優(yōu)勢,是治療直腸前突的良好選擇之一。
[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.
【學位授予單位】：蚌埠醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R657.1

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