直肠前突型便秘的手术新进展及预后相关因素分析

目的:探讨直肠前突型便秘的术式新进展及影响手术疗效的相关因素。方法:采取文献回顾法,对目前国内、外关于直肠前突型便秘的手术方式及预后因素进行分析和综述。结果:直肠前突型便秘的手术方式从入路大致可分为四大类:经直肠、经阴道、经会阴、经腹。就现有的文献报导上述四类手术方式的术后疗效无显著差异;而手法协助排便史、排粪造影中直肠前突内钡剂储留程度、直肠前突的大小、合并结肠慢传输及其它出口梗阻因素、一些全身性疾病等对直肠前突便秘的术后疗效均有影响。结论:便秘是一个多因素致病的结果(直肠前突仅为其中原因之一)。由于目前对便秘的病因病理等基础研究还不充分,因此临床上要注意判断直肠前突与便秘的关系,掌握好手术指征,并尽可能选择对患者损伤小、痛苦少的手术为宜。

Analysis of the New Progress of the Anterior - rectocele Constipation Operation and Its Relevant Factors in Prognosis

Objective:To investigate the new progress development of anterior-rectocele constipation operation and relevant factors which affect the curative effect of operation.Methods:The literatures in the recent years on the operation of anterior-rectocele constipation and factors effection prognosis were reviewed.Results:At present,there were four entry ways in anterior-rectocele constipation operation:trans-recta,trans-perineal,trans-vaginal and trans-abdominal.From the reports of present literature,there was not obvious difference in the curative effect of these four ways.But application of digital vaginal pressure to facilitate defecation,retention of the barium after defecography,the extent of anterior rectocele,slow transit conspation,complication of other outlet obstruction factors and some systemic diseases might all affect the operative efficacy.Conclusions:Constipation was caused by multiple factors(anterior rectocele is only one of these factors).The basic research on the etiology and pathology of constipation was insufficient.Therefore the judgment of the relationships between anterior rectocele and constipation was important.It was necessary to handle operative indication and select the operation which causes less pain and less damage to the patients.