经阴道修补术治疗直肠前突48例

目的探讨经阴道修补术治疗直肠前突的效果.方法：对48例Ⅱ、Ⅲ度直肠前突的患者采用经阴道修补术治疗,依据Longo ODS便秘问卷调查,观察术前、术后2周及6个月的症状改善情况.结果：术后2周总有效率为96%,术后2周及6个月主要症状均较治疗前明显改善（P〈 0.05）.结论：经阴道修补术治疗直肠前突,纠正了直肠阴道隔薄弱区,加强了直肠的支撑作用,针对性强,效果可靠.     

改良经阴道切开修补术治疗直肠前突29例临床体会

为降低经阴道切开阴道后壁黏膜行直肠前突修补术的复发率和阴道狭窄的并发症,我科自1998年起结合妇产科经阴道行阴道后壁膨出修复术的手术特点后改良经阴道切开阴道后壁黏膜行直肠前突修补术,并用多余的阴道黏膜作为补体加固直肠阴道隔术治疗直肠前突29例,疗效确切,5年长期疗效观察无一复发,无一阴道狭窄并发症出现.现报告如下.     

两种术式治疗重度直肠前突56例疗效比较

对经肛门和经阴道两种路径修补直肠前突进行疗效分析,将32例采用经肛行PPH加直肠前壁折叠缝合术和24例经阴道修补术的直肠前突患者的临床资料进行分析总结。结果显示,经肛组总有效率96．9％,经阴道组总有效率91．7％（P〉0．05）。经肛组手术、住院时间较经阴道组短（P〈0．01）,但术后创口愈合时间明显延长、疼痛明显（P〈0．05）。结果表明,两种术式修补直肠前突均安全有效,经肛PPH加直肠前壁折叠缝合术在手术适应症、疗效等方面比经阴道修补更为优越,术前应全面了解有无同时存在的各种其他盆底薄弱引起出口梗阻的异常情况,选择恰当的手术方式。     

经阴道修补加固术治疗中重度直肠前突的临床研究

为观察和评价经阴道修补加固术治疗中重度直肠前突的临床疗效,将60例中重度直肠前突患者随机分成治疗组和对照组,治疗组行经阴道修补加固术,对照组行经直肠修补术,观察比较两组患者的近远期疗效、术后出血、肛门坠胀疼痛及感染情况。结果显示,治疗组术后3个月及1年总有效率均明显高于对照组,P〈0．05;且治疗组患者术后出血、肛门坠胀疼痛及感染的总发生率明显低于对照组,P〈0．05。结果表明,与经直肠修补术相比,经阴道修补加固术治疗中重度直肠前突具有术后并发症少、疗效稳定、远期疗效好等优点。     

国产吻合器治疗直肠前突的临床应用(附30例报告)

直肠前突实际上是多指女性直肠前壁和阴道后壁之间肌层组织薄弱,引起直肠前壁向阴道突出形成的一个疝囊,患者常常大便滞留此处而感到排便困难或排便不尽感等症状,是出口梗阻型便秘的常见原因之一.以往对中度以上的直肠前突采用经阴道或经肛门行直肠前突的修补术,其手术时间长,常常疗效不确定.我院2005年9月至2006年3月,采用上海六厂生产的痔上黏膜环切吻合器对15例女性患者行PPH术式治疗直肠前突,疗效满意.     

经阴道后壁上下和左右折叠缝合术治疗直肠前突性便秘

直肠前突是指直肠壁经阴道后壁向阴道内突出，中、重度前突的患者多需手术治疗。目前手术多经肛门进行，并发症多，远期疗效欠佳。我们设计经阴道后壁上下、左右折叠缝合术，直肠前壁黏膜下作支撑性硬化剂注射的方法治疗４２例，取得满意疗效，报告如下。临床资料４２例全部为已婚经产妇女。年龄２９～６３（平均４７．３）岁。病程０．５～１２（平均５．８）年。均有便秘史，排便时间２～９（平均３．５）d１次。长期服泻药者２２例，经常用开塞露或灌肠排便者１８例，经常手掏排便者１４例，半年内基本靠手掏排便者４例。直肠指检：肛管…     

经会阴耻骨直肠肌插入间置法治疗低位直肠阴道瘘

直肠阴道瘘（rectovaginal fistulas，RVF）是连接直肠前壁和阴道后壁之间异常的病理性管道，内衬上皮细胞。RVF可导致女性生理、心理和社会问题。其初次手术修补成功率70％～100％，再次或多次修补成功率40％。85％。本文报道我院10年来采用经会阴耻骨直肠肌插入间置法治疗的10例RVF的诊治体会。     

直肠移动瓣修补先天性直肠阴道瘘

目的 探讨直肠移动瓣修补先天性直肠阴道瘘的临床治疗效果.方法 设计直肠移动瓣,充分游离移动瓣直肠粘膜,无张力修补直肠瘘口,且直肠壁缺损与阴道壁缺损分别关闭,缝合不在同一水平面上.结果 12例患者经手术治疗均治愈,随访1年～9年,无复发、肛门失禁并发症.结论 对于低位先天性直肠阴道瘘,直肠移动瓣修补术疗效确切,值得推广,术前充分肠道准备、术中规范操作对保证手术成功至关重要.     

直肠阴道瘘的病因与治疗

直肠阴道瘘（rectovaginal fistula，RVF）是连接直肠前壁和阴道后壁之间的异常病理性管道，内衬上皮细胞。RVF治疗困难，初次手术修补成功率为70％～100％，再次或多次修补成功率为40％～85％。[第一段]     

经阴道纵切横缝术治疗直肠前突的临床观察

目的提高直肠前突所致出口梗阻性便秘的治疗效果,减少直肠前突修补术后并发症和后遗症。方法将经过排粪造影检查证实直肠前突深度在30 mm及以上的146例患者随机分为观察组(74例)和对照组(72例),观察组患者用改良设计的经阴道纵切横缝术,对照组患者用经典术式经阴道纵切纵缝术。结果观察组1例无效,总有效率98．7%；疗程(11．0±1．9)d。术后随访1年,无感染及明显后遗症；对照组8例无效,总有效率88．9%,疗程(17．4±1．6)d,40．3%的患者出现并发症和后遗症。结论改良的经阴道纵切横缝术治疗直肠前突具有疗效好、疗程短,后遗症少等优点。     

The surgical anatomy of rectocele and anterior rectal wall intussusception

The aim of the study was to analyse the dynamic anatomical supports of the posterior vaginal wall from the perspective of rectocele and rectal intussusception repair. Two groups of patients were studied. Group 1 (n = 24) with genuine stress incontinence but no major vault prolapse had vagino/proctomyograms and transperineal ultrasound examinations. Group 2 with vaginal vault prolapse, clinical rectoceles and obstructive defecation symptoms (n = 19 had single-contrast defecating proctography before and after posterior-sling surgery. The posterior vaginal wall is suspended between perineal body, which underlies half its length, and uterosacral ligaments, which also support the anterior wall of rectum. Muscle forces stretch the vagina and rectum against the perineal body and uterosacral ligaments, creating shape and strength, like a suspension bridge. Postoperative proctogram studies indicated that anterior rectal wall intussusception has the same etiology as rectocele, deficient recto-vaginal ligamentous support. Repair to uterosacral ligaments and perineal body should be considered with large rectoceles, anterior rectal wall intussusception and obstructive defecation disorders.     

直肠癌盆腔清扫术后带蒂回肠段修复阴道

目的探讨直肠癌行扩大的后盆腔清扫术,其全阴道切除或后侧壁切除后修复阴道的方法。方法１９９０年～１９９７年,对５例直肠癌行盆腔后清扫术,采用带蒂回肠段修复阴道,其中带蒂回肠段修复全阴道２例,带蒂回肠段,从对系膜缘剪开作阴道后侧壁修复３例。结果５例手术均获成功。随访６个月～６年,修复后的阴道宽度适当,壁较厚,弹性良好,周围瘢痕组织少。结论用带蒂回肠段作阴道修复,取材简便,回肠系膜血管弓有足够的长度可将回肠段移位至会阴部。回肠血供良好,易于愈合,是直肠癌后盆腔清扫术后阴道成形的理想方法     

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.     

直肠癌阴道后壁切除后子宫肌瓣即时修复的探讨

目的探讨直肠癌阴道后壁切除后的修复方法。方法１９９１年８月～１９９６年３月对１０例直肠癌累及阴道后壁患者,采用一并切除阴道后壁,即时用带蒂子宫肌瓣修复阴道后壁。结果术后除１例因子宫肌瓣血供不佳失败外,其余效果满意。术后３～６个月复查,阴道后壁痊愈７例,阴道宽度为２～３指,深度为５～６ｃｍ。结论用带蒂子宫肌瓣修复阴道后壁,取材方便,手术操作简便易行,对直肠癌累及阴道后壁需一并切除者的修复优为适宜     

Laparoscopically assisted anorectovaginoplasty for selected types of female anorectal malformations

Purpose: The aim of this study was to describe laparoscopically assisted anorectovaginoplasty (LAARVP) for the repair of selected types of female anorectal malformation.Methods: Five cases (case 1, rectovaginal fistula with a high rectum; case 2, rectovestibular fistula with double vagina; case 3, rectovestibular fistula with absent vagina; case 4, anovestibular fistula with absent vagina; case 5, cloaca) were reviewed.Results: Patient 4 had undergone a posterior sagittal anorectoplasty without vaginoplasty at another hospital after misdiagnosis of simple anovestibular fistula. Mean age at LAARVP was 15.4 months. At LAARVP, the fistula was divided in cases 1 through 4 and dissected as low as possible in case 5. In cases 3 and 4, the distal fistula was used to create the neovagina. In cases 1 through 3, the proximal rectum was mobilized and brought through the pelvic floor sphincter muscles using Georgeson’s laparoscopically assisted colon pull-through technique through a minimal perineal incision. A posterior sagittal incision was required in cases 4 and 5. However, the initial laparoscopic approach was very helpful in both cases. Currently, all patients are well after a mean follow-up period of 32.2 months. Mean current age is 4.0 years. Patients 1 through 3 are continent, patient 4 is incontinent with soiling, and patient 5 is too young to be evaluated.Conclusions: LAARVP helps to achieve low dissection of the fistula, gives optimal view of the pelvic organs, provides accurate placement of the anorectal pull-through, and minimizes abdominal perineal scars.     

Histological features of the rectovaginal septum in elderly women and a proposal for posterior vaginal defect repair

To get support from morphological findings to develop a novel surgical procedure for posterior vaginal defect repair, we histologically examined the rectum–vagina interface tissues obtained from 20 elderly female cadavers. The rectovaginal septum (RVS) was defined here as an elastic fiber-rich plate (EFRP) along the posterior vaginal wall. It lined the posterior surface of the vein-rich zone of the vaginal wall and extended between the bilateral paracolpiums. The septum was more evident in the lower half of the interface than in the upper half. The RVS was often thin and interrupted. Since the RVS was not so clearly demonstrated in the upper vagina histologically, augmentation using some implant is considered to be necessary for the enterocele and high rectocele. Since the thickness and tightness of the RVS vary with the case in the lower vagina, surgical procedures for low rectocele repair should be individualized, including implant-augmentation.     

阴式子宫切除术联合阴道前后壁修补术对子宫脱垂合并阴道壁膨出患者术后疼痛及复发的影响

目的探讨阴式子宫切除术联合阴道前后壁修补术对子宫脱垂合并阴道壁膨出患者术后疼痛及复发的影响。 方法选取2017年1月到2019年1月,安徽省马鞍山市中心医院收治的90例子宫脱垂合并阴道壁膨出患者。采用随机数字表法将其分为对照组和观察组。对照组45例采用单纯阴道前后壁修补术进行治疗,观察组45例采用阴式子宫切除术联合阴道前后壁修补术进行治疗,2组术后随访1年。比较2组治疗后的临床疗效及手术前后视觉模拟评分（VAS）;统计2组围手术期手术相关指标及并发症发生率和随访1年的复发率。采用SPSS 21.0统计软件进行数据分析。 结果观察组总有效率为93.33%,显著高于对照组的71.11%,差异有统计学意义（P<0.05）。与手术前相比,术后3～7 d,2组VAS评分均呈逐渐降低趋势,且术后3、7 d观察组显著低于对照组,差异有统计学意义（P<0.05）。与对照组相比,观察组术中出血量明显较少,差异有统计学意义（P<0.05）;观察组的住院时间、肛门排气时间、手术时间等明显较短,差异有统计学意义（P<0.05）。观察组并发症发生率、随访1年复发率分别为6.67%、2.22%,显著低于对照组的26.67%、24.44%,差异有统计学意义（P<0.05）。 结论阴式子宫切除术联合阴道前后壁修补术治疗子宫脱垂合并阴道壁膨出,可显著改善患者围手术期相关指标的情况,减轻患者术后疼痛,并能降低患者并发症发生率及术后复发率,临床疗效显著。     

顽固结肠慢传输性便秘16例的临床分析

目的：探讨顽固性结肠慢传输性例秘的合理治疗方法。方法：总结顽固性结肠慢传输性便秘患者经X线钡灌肠以及排粪造影检查,结合临床特征而决定手术切除冗长结肠12例,4例非手术治疗,其中冗长横结肠4例,冗长乙状结肠12例。伴直肠前凸3例,重度直肠膨出,盆底下降1例,4例患者中3例经肛修复,1例经腹修复,重建盆底。3例乙状结肠冗长扭转行急诊手术。结果：11例患者恢复良好,有1例高龄患者仅行扭转乙状结肠复位而于术后10d死亡,随访3年,1例有肠粘连症状,1例切口感染,4例非手术治疗症状未缓解。结论：顽固性结肠慢传输性便秘冗长结肠是其原因之一,需早期手术切除,伴有直肠前凸,盆底下降可一期手术修复,如待急诊肠扭转再手术,则危险较大、甚至危及生命,而非手术治疗症状不得缓解,且造成药物依赖。