直肠黏膜环切术联合直肠黏膜切除肌层折叠缝合术治疗Ⅱ度和Ⅲ度直肠脱垂的临床疗效

Clinical efficacy of PPH combined with rectal mucosal resection and myometrial folding in patients with grade Ⅱ and grade Ⅲ rectal prolapse

摘要:

目的 探讨直肠黏膜环切术（PPH）联合直肠黏膜切除肌层折叠缝合术（Delorme手术）治疗Ⅱ度和Ⅲ度直肠脱垂（RP）的临床疗效。方法 选择2018年3月－2021年3月该院接受诊治的82例Ⅱ度和Ⅲ度RP患者作为研究对象，随机分为A组（n = 41）与B组（n = 41）。A组行PPH联合Delorme手术，B组行传统PPH。比较两组患者临床疗效、术后视觉模拟评分（VAS）、肛管功能、排便情况和术后1个月并发症发生情况。结果 A组总有效率明显高于B组（P < 0.05）；术后3和7 d，A组VAS明显低于B组（P < 0.05）；与治疗前相比，两组患者术后90 d直肠黏膜感觉阈值明显升高（P < 0.05），肛管功能长度明显缩短（P < 0.05），且A组直肠黏膜感觉阈值明显高于B组，肛管功能长度明显短于B组；A组术后1个月的控便能力评分明显低于B组，排便时间明显短于B组，排便次数明显少于B组（P < 0.05）；A组术后1个月排尿不正常、发热、排便困难和吻合口感染发生率明显低于B组（P < 0.05）。结论 相较于传统PPH，采用PPH联合Delorme手术治疗Ⅱ度和Ⅲ度RP，临床治疗效果更佳，可有效地减轻患者术后疼痛，改善肛管功能，增强患者控便能力，降低术后并发症发生率。

Abstract:

Objective To investigate the clinical effect of procedure for prolapse and hemorrhoids (PPH) combined with rectal mucosal resection and myometrial folding (Delorme) in patients with grade Ⅱ and grade Ⅲ rectal prolapse (RP).Methods From March 2018 to March 2021, 82 patients with second-degree and third-degree RP were selected as research objects, and divided into A group (n = 41) and B group (n = 41). The group A performed PPH combined with Delorme surgery, and the group B performed traditional PPH surgery. The clinical efficacy, postoperative visual analogue scale (VAS), functions of anus, bowel movements, and complications in the postoperative 1 month were compared between the two groups.Results The total effective rate of group A was significantly higher than that of group B (P < 0.05). On postoperative days 3 and 7, VAS in group A was significantly lower than that in group B (P < 0.05). Compared with before treatment, the threshold of rectal mucosa sensation was significantly increased (P < 0.05) and the functional length of anal canal was significantly shortened (P < 0.05) in both groups 90 d after surgery, and the threshold of rectal mucosa sensation in group A was significantly higher than that in group B, and the functional length of anal canal was significantly shorter than that in group B. The score of defecation control ability of group A was significantly lower than that of group B one month after operation, the defecation time was significantly shorter than that of group B, and the defecation frequency was significantly less than that of group B (P < 0.05). The incidence of abnormal urination, fever, difficulty defecation and anastomotic infection 1 month after operation in group A was significantly lower than that in group B (P < 0.05).Conclusion Compared with traditional PPH surgery, the clinical treatment effect of patients with second-degree and third-degree RP is better by PPH combined with Delorme surgery, which can effectively reduce postoperative pain, improve canal function, enhance patients' ability to control the stool, and reduce the incidence of postoperative complications.