腹腔镜盆底和韧带整体修复治疗直肠内脱垂的围手术期加速康复护理的对比研究

目的探讨在盆底整体理论指导下腹腔镜盆底和韧带整体修复手术治疗直肠内脱垂的早期疗效以及加速康复外科围手术期护理方法有效性的对比研究。 方法研究对比2017年3月至2019年11月间行手术治疗82例直肠内脱垂患者的临床资料，40例采用传统围手术期护理（对照组），42例采用加速康复外科围手术期护理（观察组）。比较两组患者首次排气时间、住院时间、手术出血量、住院费用以及术后并发症的发生率；并且比较两组患者术前和术后3个月直肠脱垂程度（DIRP）、Wexner便秘评分（WCS）、胃肠生活质量指数（GIQLI）及Wexner肛门失禁评分（WIS）。 结果观察组在首次排气时间、住院时间和住院费用明显优于对照组（t=4.991，9.651，10.494；P<0.001）。比较两组术前与术后3个月患者的DIRP、WCS、GIQLI、WIS，结果显示各项指标均得到明显改善（t_对照组=44.826、16.794、9.459、-5.477，t_观察组=44.077、18.504、17.405、-19.730；P<0.001）。观察组术后3个月WCS、GIQLI、WIS与对照组比较均明显改善（t=2.734，11.005，-3.916；P<0.001），两组术后Clavien-Dindo Ⅰ~Ⅲ级并发症比较差异无统计学意义。 结论在盆底整体理论指导下腹腔镜盆底和韧带整体修复手术治疗直肠内脱垂，创伤小、并发症少、临床效果好。采用加速康复外科围手术期护理措施和方法能够明显加快术后康复速度，早期恢复肠道功能，缩短住院时间，减少住院费用，提高患者生活质量。

A comparative study of perioperative rapid rehabilitation nursing for laparoscopic pelvic floor and ligament overall repair in the treatment of internal rectal prolapse

ObjectiveTo explore the early effect of laparoscopic pelvic floor and ligament overall repair in the treatment of internal rectal prolapse under the guidance of the integral theory and the comparative study of the effectiveness of perioperative nursing methods in fast track surgery. MethodsThe clinical data of 82 patients with internal rectal prolapse treated by operation from March 2017 to November 2019 were compared, forty cases were treated by traditional perioperative nursing (control group), and 42 cases were treated by perioperative nursing of fast track surgery (observatuin group). Comparing the first ventilation time of the two groups, hospital stay, surgical bleeding, hospital cost and incidence of postoperative complications; and preoperative and postoperative a comparative observation of the degree of internal rectal prolapse (DIRP), Wexner constipation scale (WCS), gastrointestinal quality of life index (GIQLI) and Wexner incontinence scale (WIS) at 3 months. ResultsFirst ventilation time, hospital stay and hospital cost of observatiun group were significantly better than those of control group (t=4.991, 9.651, 10.494; P<0.001). The DIRP, WCS, GIQLI, and WCS of the two groups of patients before and after 3 months of operation were compared, and the results showed that all indicators were significantly improved (t_control=44.826, 16.794, 9.459, -5.477, t _observatiun=44.077, 18.504, 17.405, -19.730; P<0.001). WCS, GIQLI, and WIS of observation group were significantly improved compared with control group (t=2.734, 11.005, -3.916; P<0.001). There was no significant difference in Clavien-Dindo grade Ⅰ~Ⅲ postoperative complications between the two groups. ConclusionUnder the guidance of the integral theory, laparoscopic pelvic floor and ligament overall repair surgery for internal rectal prolapse has the advantages of less trauma, fewer complications, and good clinical results. Adopting fast track surgery perioperative nursing measures and methods can significantly accelerate postoperative rehabilitation, restore intestinal function early, shorten hospital stay, reduce hospital cost, and improve patients' quality of life.