【摘要】：目的:探討改良經(jīng)肛吻合器直腸部分切除術(shù)(Improved STARR)聯(lián)合圍手術(shù)期盆底生物反饋治療排糞障礙綜合征(ODS)的臨床療效及安全性。方法:回顧性分析2014年10月到2016年1月吉林大學(xué)第一醫(yī)院結(jié)直腸肛門(mén)外科行改良STARR手術(shù)聯(lián)合圍手術(shù)期生物反饋治療的30例女性排糞障礙綜合征患者的相應(yīng)臨床資料。全組患者均在進(jìn)行1個(gè)療程盆底生物反饋治療(治療時(shí)間20 min/次、2次/d、10次為1個(gè)療程)后行改良STARR手術(shù),出院后于門(mén)診繼續(xù)行2個(gè)療程的盆底生物反饋治療。療效評(píng)估指標(biāo)包括患者一般情況及術(shù)后并發(fā)癥情況、治療前后患者的主觀感受分級(jí)(極好:無(wú)任何不適癥狀;好:每月應(yīng)用1~2次緩瀉劑且不需手指或灌腸等輔助排便;良:每月3次及以上應(yīng)用緩瀉劑;差:癥狀沒(méi)有改善)、Longo ODS評(píng)分(分值范圍為0~40分,分值越高,癥狀越嚴(yán)重)、胃腸生活質(zhì)量評(píng)分(分值范圍為0~144分,分值越低,癥狀越嚴(yán)重)、直腸肛管測(cè)壓與排糞造影檢查情況。隨訪時(shí)間截至術(shù)后12個(gè)月(2017年2月)。結(jié)果:(1)30例女性患者均順利完成手術(shù),平均手術(shù)時(shí)間25(18~34)分,平均術(shù)后住院時(shí)間6(4~9)天。術(shù)后并發(fā)癥:疼痛20%(6/30)、尿潴留16.7%(5/30)、肛門(mén)墜脹感6.7%(2/30)、急便感26.6%(8/30)。其中,患者肛門(mén)墜脹感、急便感均于術(shù)后1~3月內(nèi)逐漸減弱并消失,未出現(xiàn)術(shù)后出血、感染、直腸陰道瘺、吻合口裂開(kāi)和肛門(mén)失禁等嚴(yán)重并發(fā)癥。術(shù)后隨訪12月,患者主觀感受總有效率為93.3%(28/30),無(wú)效率為6.7%(2/30)。(2)全組患者治療開(kāi)始前及治療后手術(shù)前Longo ODS評(píng)分較為接近(治療前:32.95±3.22,治療后手術(shù)前:32.85±3.62,t=1.472,P=0.163),但與治療開(kāi)始前相比,行改良STARR手術(shù)后患者ODS評(píng)分下降(t=4.306,P=0.000),其中術(shù)后1月ODS評(píng)分較術(shù)后1周明顯下降(13.05±7.49比15±7.17,t=7.322,P=0.000),術(shù)后1、3、6和12月時(shí)患者ODS評(píng)分穩(wěn)定,差異無(wú)統(tǒng)計(jì)學(xué)意義(F=2.111,P=0.107)。全組患者治療開(kāi)始前及術(shù)前GIQLI評(píng)分無(wú)顯著差異(治療前:79.39±17.14,治療后手術(shù)前:76.65±17.56,t=1.735,P=0.096),但與治療開(kāi)始前相比,行改良STARR手術(shù)后患者GIQLI評(píng)分上升(t=4.714,P=0.000),其中術(shù)后1月GIQLI評(píng)分較術(shù)后1周升高(102.26±19.24比91.31±21.35,t=5.628,P=0.000),術(shù)后1、3、6和12月時(shí)患者GIQLI評(píng)分穩(wěn)定,差異無(wú)統(tǒng)計(jì)學(xué)意義(F=1.211,P=0.313)。(3)與治療前相比,術(shù)后12個(gè)月排糞造影檢查顯示,患者直腸前突及直腸內(nèi)套疊程度明顯改善,其中直腸前突從(34.1±0.4)mm下降至(3.1±0.3)mm(t=6.847,P=0.000)。力排相肛直角從(123.8±6.7)°上升到(134.7±8.5)°,力排時(shí)肛直角開(kāi)大角度從(29.1±3.5)°上升到(37.1±5.3)°,但會(huì)陰下降程度、靜息相肛直角與術(shù)前相比較,無(wú)統(tǒng)計(jì)學(xué)差異(均P0.05)。(4)治療前后肛管靜息壓、肛管最大收縮壓、直腸排糞壓、直腸排糞感覺(jué)閾值及直腸最大耐受量等相應(yīng)直腸肛管測(cè)壓參數(shù)并未顯示出明顯的差異(均P0.05)。結(jié)論:改良經(jīng)肛吻合器直腸切除術(shù)(Improved STARR)聯(lián)合圍手術(shù)期盆底生物反饋治療ODS是安全的、有效的。
[Abstract]:Objective: to evaluate the clinical efficacy and safety of modified transanal stapler rectal partial resection (Improved STARR) combined with pelvic floor biofeedback in the treatment of defecation disorder syndrome (ODS). Methods: the clinical data of 30 female patients with defecation disorder syndrome treated by modified STARR operation and biofeedback during perioperative period from October 2014 to January 2016 in the first Hospital of Jilin University were retrospectively analyzed. All patients underwent a course of pelvic floor biofeedback therapy (20 min/ 10 times as a course of treatment) and then underwent modified STARR operation. After discharge from the hospital, the patients received two courses of pelvic floor biofeedback therapy. The evaluation indexes of curative effect included the general condition of the patients and the complications after operation, the subjective feeling grading of the patients before and after treatment (excellent: no discomfort, good: 1 or 2 times a month with no finger or enema and other auxiliary defecation; Good: three or more times a month with laxatives; poor: symptoms did not improve) Longo ODS score (score range 0 ~ 40, the higher the score, the more serious symptoms), gastrointestinal quality of life score (score range of 0 ~ 144 points, the lower the score, the higher the score, the more serious the symptoms are, the lower the score is, the higher the score is, the more serious the symptoms are. The more serious the symptoms, the more the rectoanal manometry and defecography. The follow-up period was 12 months (February 2017). Results: (1) 30 female patients completed the operation successfully, the average operative time was 25 (18 / 34) and the average postoperative hospitalization time was 6 (4 / 9) days. Postoperative complications: pain 20% (6 / 30), urinary retention 16. 7% (5 / 30), anal bloating 6. 7% (2 / 30), irritation 26. 6% (8 / 30). There were no serious complications such as postoperative bleeding, infection, rectovaginal fistula, anastomotic opening and anal incontinence. The total effective rate of subjective feeling was 93.3% (28 / 30), and the ineffective rate was 6.7% (2 / 30). (_ 2). The Longo ODS scores before and after treatment were similar (before treatment: 32.95 鹵3.22, before treatment: 32.85 鹵3.62t 1.472P 0.163), but compared with that before treatment. After the modified STARR operation, the ODS score of the patients decreased (t = 4.306 P0. 000), and the ODS score in 1 month after operation was significantly lower than that in the first week (13.05 鹵7.49 vs 15 鹵7.17). The ODS score of the patients was stable at 1 and 12 months after the operation (F2.111, P0. 107). There was no significant difference in GIQLI scores before and before treatment (1: 79. 39 鹵17. 14 before treatment and 1. 735% before operation after treatment), but there was no significant difference between the two groups before and after treatment. However, there was no significant difference between the two groups before and after treatment, but there was no significant difference between the two groups before treatment and before treatment (P < 0. 096). The GIQLI score of the patients undergoing modified STARR operation increased (t = 4.714p 0.000), and the GIQLI score in 1 month after operation was higher than that in the first week after operation (102.26 鹵19.24 vs 91.31 鹵21.35 t 5.628P 0.000). The GIQLI score was stable at 1 month after operation and 12 months after operation (F1.211P 0.313). (3), and there was no significant difference between the two groups (F1.211P0.313). (3). 12 months after operation, defecography showed that the degree of rectum protrusion and rectum intussusception was significantly improved, in which rectal protrusion decreased from (34.1 鹵0.4) mm to (3.1 鹵0.3) mm (/ t 6.847). The angle of anal right angle increased from (123.8 鹵6. 7) 擄to (134.7 鹵8. 5) 擄, and the wide angle of right angle of anal angle increased from (29. 1 鹵3. 5) 擄to (37. 1 鹵5. 3) 擄. However, the degree of perineum decreased, and there was no significant difference in resting anal right angle between before and after treatment (P0.05). (4). The parameters of rectal anal manometry such as rectal defecation pressure, rectal defecation sensory threshold and rectal maximum tolerance dose did not show significant difference (P0.05). Conclusion: (Improved STARR) combined with pelvic floor biofeedback in perioperative period is safe and effective in the treatment of ODS.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R657.1

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