痔上黏膜切除钉合术加直肠前壁修补术治疗直肠前突56例体会

目的 探讨选择性痔上黏膜切除钉合术（TST）加直肠前壁修补术治疗中重度直肠前突的临床效果.方法 回顾性分析2011年1月至2013年6月我院采用TST加直肠前壁修补术治疗直肠前突56例临床资料.结果 随访6～24个月,痊愈45例（80.36％）,显效8例（14.29％）,有效3例（5.35％）,总有效率100％.结论 TST加直肠前壁修补术治疗重度直肠前突具有创伤小、操作简单,并发症少、恢复快、复发率低、安全经济的优点.     

Consensus conference on the stapled transanal rectal resection (STARR) for disordered defaecation

An international working party was convened in Rome, Italy on 16-17 June, 2005, with the purpose of developing a consensus on the application of the circular stapling instrument to the treatment of certain rectal conditions, the so-called Stapled Transanal Rectal Resection (STARR). Since the procedure has been submitted to only limited objective analysis it was felt prudent to hold a meeting of interested individuals for the purpose of evaluating the current status and to make conclusions and recommendations concerning the applicability of this new approach.     

前突修补联合耻骨直肠肌切断术治疗女性便秘（初步报告）

便秘的成因很多，直肠前突是女性便秘的主要原因之一。前突修补术是治疗由直肠前突引起的便秘的主要手术术式。作者在诊治便秘的过程中，对于明确诊断为中度以上的直肠前突患者，经过前突修补术的治疗．症状优良改善率仅半数左右，结合临床的体征、进一步分析排粪造影响有X线图像，一些患者的耻骨直肠肌在力排时不放松，甚至有反常收缩，X线则显示直肠下段后壁有改变不多的切迹存在，因而采用前突修补联合耻骨直肠肌切断术的术式，提高了手术后的疗效。文章详细介绍了半环状切口切断耻骨直肠的改进的手术术式，以供同道们共同研究。     

Abdominal sacral colpoperineopexy: A new approach for correction of posterior compartment defects and perineal descent associated with vaginal vault prolapse

OBJECTIVE: Our purpose was to assess a modification of abdominal sacral colpopexy in 19 patients. STUDY DESIGN: The rectovaginal space was dissected to the superior aspect of the posterior vaginal fascia still contiguous with the perineal body. Mersilene (Ethicon, Somerville, N.J.) mesh was sutured to this fascia and along the entire posterior vaginal wall. Patients with vault prolapse, perineal descent, and associated rectoceles or enteroceles are reported. Outcome measures included bowel symptoms and pelvic organ prolapse staging. Defecography was performed in three patients. Wilcoxon signed rank analysis was used for comparison of prolapse measures. RESULTS: Mean follow-up was 11 weeks. Bowel symptoms improved in 8 of 11 women. No subjects had greater than stage II prolapse postoperatively and median improvement in stage was 3 (range 2 to 4). The mean decrease in the genital hiatus measurement was 3.13 ± 1.25 (range 2 to 6) cm. Postoperative defecography documented correction of rectoceles and enteroceles and improvement in perineal descent with straining. CONCLUSIONS: Abdominal sacral colpoperineopexy is effective surgery for vaginal vault prolapse associated with perineal descent and posterior vaginal defects.(Am J Obstet Gynecol 1997;177:55)     

肠管直肠脱垂肠壁神经丛神经元形态结构的改变

用光镜和电镜观察乙状结肠直肠全层脱垂肠段肠壁内神经丛神经元的形态结构改变。结果表明，脱垂肠管的肌间神经丛和粘膜下神经丛的神经细胞发生尼氏体溶解或浓缩呈团块状，细胞核偏位和浓缩变小，细胞肿大或萎缩，神经节内细胞减少，胶质细胞增生；电镜下可见神经细胞粗面内质网肿胀、脱颗粒，线粒体肿大、嵴消失或呈空泡，高尔基复合体扩张等超微结构的改变。认为肠管直肠脱垂时肠壁内神经丛的损害在此病发生发展过程中，可能起着重要作用。     

Nonsurgical Treatment Options for Women With Pelvic Organ Prolapse

Pelvic organ prolapse is a medical condition that can cause pelvic discomfort as well as urinary and bowel complications. Approximately 25% of women in the United States and roughly 50% of women worldwide develop this condition. Although pelvic organ prolapse is usually a non–life-threatening condition, it can result in decreased self-confidence and negative body image. Physical and emotional sequelae can limit physical activity, and decreased productivity could be a consequence. Evidence from the literature indicates that pessary use and pelvic floor muscle training are effective options when conservative treatment is desired. Additional research is necessary to determine long-term outcomes in women who choose nonsurgical treatments. Nonsurgical options are important for women for whom surgery is contraindicated or not preferred.     

腹腔镜下自体组织修复手术在纠正女性盆腔器官脱垂中的应用

腹腔镜手术在妇科领域应用广泛,近来更是成熟应用于女性盆底功能障碍性疾病的诊治中。在经阴道网片修复手术应用受限的背景下,自体组织修复的盆底重建术再次受到重视。相对于经阴道途径,腹腔镜下的自体组织修复手术报道相对较少,但随着腹腔镜技术、设备以及机器人手术等领域的创新,腹腔镜下的盆底重建手术也定将得到进一步发展。文章就腹腔镜下自体组织修复手术在纠正女性盆腔器官脱垂中的应用做一综述,为妇科医师选择术式提供参考。     

Short-term results for laparoscopic ventral rectopexy using biological mesh for pelvic organ prolapse

Aim There is growing evidence that laparoscopic ventral rectopexy (LVR) is an effective treatment for pelvic organ prolapse and obstructive defaecation caused by rectocele. LVR is usually performed using synthetic mesh despite concerns about mesh erosion. We present our experience of using a porcine dermal collagen mesh (Permacol?) for LVR, which is the largest such case series to date. Method Data on 65 patients were collected prospectively from May 2008 to October 2010. Outcome measures were complications, recurrence, length of hospital stay, patient satisfaction, Wexner constipation score and Wexner incontinence score. Preoperative and postoperative scores were compared using the two‐tailed Wilcoxon signed rank test. P < 0.05 was considered statistically significant. Results There were statistically significant improvements in the Wexner constipation scores at 6 months and 1 year (both P < 0.0001) and in faecal incontinence scores at 6 months (P < 0.0001) and 1 year (P = 0.0002). There were no cases of mesh erosion or mesh‐related infection in our series. Recurrence of symptoms occurred in two patients (3.1%). Symptoms were rated as much better or better by 93% of patients at 6 months and this was sustained at 1 year (96%). Conclusion In the short term, LVR using biological mesh is safe and as effective as synthetic mesh, with high patient satisfaction. Constipation and faecal incontinence scores were both improved.