改良经肛外直肠黏膜下层柱状注射术对Ⅰ、Ⅱ度直肠脱垂疗效的观察

目的探讨改良经肛外直肠黏膜下层柱状注射术对Ⅰ、Ⅱ度直肠脱垂的疗效。方法对60例Ⅰ、Ⅱ度直肠脱垂患者行改良经肛外直肠黏膜下层柱状注射术治疗。结果治疗后随访1年以上,痊愈58例,占96.67%;好转2例,占3.33%。结论改良经肛外直肠黏膜下层柱状注射术对Ⅰ、Ⅱ度直肠脱垂具有创伤小,操作简便,生效快,临床治愈率高,不易复发等优点。     

环切并纵切手术治疗直肠黏膜内脱垂

目的:探讨直肠黏膜内脱垂有效的手术治疗方法。方法:对48例患者采取经肛以PPH环形切除松弛直肠黏膜,使肛垫悬吊加固回复至原位,吻合后分别于3、7、11点位(男性)或3、7及前正中位(女性)距吻合口以上1cm纵行柱状缝合松弛直肠黏膜,使脱垂的直肠黏膜横向及纵向同时缩短并悬吊上移。结果:术后1～3个月松弛脱垂黏膜挛缩固定,肛门坠胀、排便困难完全消失,排便时间明显缩短,每天1～2次。结论:PPH结合直肠黏膜纵行缝合悬吊术在治疗直肠黏膜内脱垂简单易行和疗效满意的方法。     

经肛三联术治疗Ⅲ度直肠脱垂15例临床体会

目的探讨经肛三联术（即直肠黏膜柱状排列结扎术、直肠周围间隙注射术、肛门环缩术）治疗Ⅲ度直肠脱垂的临床效果。方法对我院2006～2009年采用经肛三联术治疗Ⅲ度直肠脱垂的15例患者进行回顾性分析。结果 15例患者全部治愈,无1例复发,疗效满意。结论经肛三联术治疗直肠脱垂创伤小、痛苦少、疗效确切、并发症少、无后遗症,是一种微创、无痛、安全可靠的术式,值得临床推广。     

综合疗法治疗老年人直肠脱垂77例分析

目的探讨综合疗法治疗老年人直肠脱垂的临床疗效。方法对77例老年人直肠脱垂患者采用直肠黏膜柱状结扎术和黏膜下注射术、缩肛术及直肠周围注射术等综合疗法治疗的临床资料作回顾性分析。结果患者均一次性治愈,随访0．5～2年均无复发,术后无并发症和后遗症。结论综合疗法治疗老年人直肠脱垂疗效确切,痛苦少,复发率低。     

三联手术治疗Ⅱ、Ⅲ度直肠脱垂临床疗效观察（附25例报告）

目的探讨采用三联手术治疗Ⅱ、Ⅲ度直肠脱垂的临床疗效。方法对25例直肠脱垂患者采用矾藤痔局部注射术、直肠黏的膜柱状缝合术及肛门紧缩术（三联手术）进行治疗临床资料进行回顾性分析。结果治愈24例,治愈率96%。结论三联手术治疗直肠脱垂具有疗效高、无复发、无后遗症的优点。     

Gant-Miwa联合肛门环缩及消痔灵注射术治疗16例直肠全层脱垂的临床观察

目的 评价Gant-Miwa联合肛门环缩及消痔灵注射术治疗直肠全层脱垂的疗效.方法 回顾性分析2011年2月-2014年11月在沈阳军区总医院接受Gant-Miwa联合肛门环缩及消痔灵注射术的16例直肠全层脱垂患者的临床资料.结果 16例患者均手术顺利,术后脱垂症状消失,3例出现尿潴留,2例出现肛周术区感染而复发,1例肛周切口延迟愈合,2例出现直肠狭窄致便秘,无大出血、肛周脓肿、肛瘘等并发症,无围手术期死亡病例.术后13例患者接受了平均2.2年的随访,2例直肠脱垂复发.结论 Gant-Miwa联合肛门环缩及消痔灵注射术治疗直肠全层脱垂手术创伤小、术后并发症少、复发率较低,经创新及改良后更值得广泛开展.     

肛门紧缩术在直肠脱垂治疗中的应用

目的 研究肛门紧缩术在直肠脱垂手术治疗中应用的可行性.方法 70例直肠脱垂Ⅲ度患者做直肠黏膜柱状缝合术和硬化剂注射术为A组,66例直肠脱垂Ⅲ度患者做直肠黏膜柱状缝合、硬化剂注射+肛门紧缩术为B组,对比其疗效.结果 术后随访2年,A组无神经系统损伤的治愈率75.93%,B组无神经系统损伤的治愈率94.12%(P=0.02),差异有统计学意义.A组有神经系统损伤的治愈率37.5%,B组有神经系统损伤的治愈率86.7%(P=0.015),差异有统计学意义.结论 肛门紧缩术是治疗直肠脱垂非常重要的术式,应作为治疗直肠脱垂的常规术式之一.     

PPH加黏膜柱状缝合、直肠周围高位注射治疗完全性直肠脱垂(附15例报告)

目的：探讨PPH加黏膜柱状缝合、直肠周围高位注射治疗完全性直肠脱垂的手术效果。方法：对15例完全性直肠脱垂（Ⅰ～Ⅱ度）患者，采用PPH加黏膜柱状缝合、直肠周围高位注射治疗。结果：治愈15例，无复发。结论：该术式操作简单，近期疗效好，远期效果有待进一步观察。     

吻合器痔上黏膜环切术(PPH)加直肠周围硬化剂注射治疗直肠脱垂28例观察

目的观察吻合器痔上黏膜环切术(PPH)加直肠周围硬化剂注射治疗直肠脱垂的临床疗效及其并发症情况。方法选择28例不同程度直肠脱垂患者,行PPH术加直肠周围硬化剂注射治疗,观察患者症状缓解情况及肛门失禁、大出血、肛周感染及肛管狭窄并发症的发生情况。结果20例患者术后首次排便即无脱出,完全回缩。术后随访半年,痊愈率96.43%,总有效率100%。全组无肛门失禁、大出血、肛周感染及肛管狭窄等。结论PPH术加直肠周围硬化剂注射治疗直肠脱垂是一种安全、有效、简单、创伤小的治疗方法,但此仅是对原有治疗手段的一种补充,仍应按病人的实际情况,选择合适的治疗手段。     

消痔灵注射+羊肠线肛周皮下紧缩术治疗完全性直肠脱垂(附22例报道)

目的探讨注射术与肛门紧缩术联合应用于完全性直肠脱垂的优势。方法回顾性分析采用消痔灵1∶1稀释液于脱垂直肠黏膜下网格点状注射和消痔灵原液于两侧坐骨直肠窝及直肠后间隙注射+羊肠线肛周皮下紧缩术治疗完全性直肠脱垂22例的临床资料。结果治愈率100%,无明显并发症及后遗症,随访3个月至2年,无复发。结论消痔灵注射+羊肠线肛周皮下紧缩术治疗直肠脱垂疗效显著,安全可靠,操作简单,创伤小,并发症少,恢复快,复发率低,且价格低廉,值得推荐。     

直肠内、外脱垂的肛管直肠动力学差异

目的探讨直肠内脱垂与直肠外脱垂的肛管直肠动力学差异。方法经排粪造影明确诊断的直肠内脱垂患者13例,直肠外脱垂患者12例,均采用ZGJ—D3型肛肠压力检测仪行直肠肛管压力测定,并与12例正常组对照分析,回顾性研究直肠肛管的动力学改变。结果直肠外脱垂与直肠内脱垂相比,肛管静息压力降低明显（5．27士2．35kPaVS12．53kPa±5．37kPa,P〈O．05）,肛管舒张压降低明显（O．93kPa±0．40kPavs3．75kPa±59kPa,P〈0．05）。结论直肠内脱垂及直肠外脱垂存在有肛管动力学差异。     

Rectal Prolapse: An Overview of Clinical Features,Diagnosis, and Patient-Specific Management Strategies

Rectal prolapse can present in a variety of forms and is associated with a range of symptoms including pain, incomplete evacuation, bloody and/or mucous rectal discharge, and fecal incontinence or constipation. Complete external rectal prolapse is characterized by a circumferential, full-thickness protrusion of the rectum through the anus, which may be intermittent or may be incarcerated and poses a risk of strangulation. There are multiple surgical options to treat rectal prolapse, and thus care should be taken to understand each patient’s symptoms, bowel habits, anatomy, and pre-operative expectations. Preoperative workup includes physical exam, colonoscopy, anoscopy, and, in some patients, anal manometry and defecography. With this information, a tailored surgical approach (abdominal versus perineal, minimally invasive versus open) and technique (posterior versus ventral rectopexy +/? sigmoidectomy, for example) can then be chosen. We propose an algorithm based on available outcomes data in the literature, an understanding of anorectal physiology, and expert opinion that can serve as a guide to determining the rectal prolapse operation that will achieve the best possible postoperative outcomes for individual patients.     

Colpocystodefecography in obstructed defecation: is it really useful to the surgeon?

Objective Colpocystodefecography images the pelvic floor with the dynamics of defecation, but various authors claim that it overestimates clinical findings. The aim of this study was to evaluate the pre‐ and postoperative consistency between clinical and colpocystodefecographic findings in patients undergoing surgery for obstructed defecation. Method Between June 2001 and September 2003, 20 patients underwent transvaginal posterior colpoperineorrhaphy and rectal mucosal prolapsectomy with one circular stapler for symptomatic rectocele and concomitant anorectal prolapse. They were prospectively evaluated both before surgery by designed questionnaire on constipation and incontinence, proctological, gynaecological and urological examinations, colpocystodefecography and anorectal manometry, and after operation at 6 months by questionnaire and a proctological check‐up. The mean follow‐up was 30 months (24–48 months). Results At 6 months the questionnaire revealed a major response in terms of symptoms. The proctological visit confirmed the absence of rectocele in 19 (95%) patients, while the anorectal prolapse had completely disappeared in 17 (85%) patients. Postoperative colpocystodefecography demonstrated a general reduction in the dimensions of the rectocele, which had completely disappeared in five (25%) patients; 40% of the patients had a persistent anorectal prolapse. Conclusion Preoperative data analysis showed a statistically significant correlation between clinical and radiological findings. Postoperatively the global clinical assessment correlated well with patient satisfaction, while there was evidence of a statistically significant difference between the radiological and clinical findings. Routine postoperative use of colpocystodefecography is unjustified unless there is clinical evidence of surgical failure.     

直肠乙状结肠部分切除联合直肠固定术治疗成人完全型直肠脱垂

目的 探讨成人完全型直肠脱垂采用直肠乙状结肠部分切除联合直肠固定术的手术疗效.方法 2006-2011年,收治的6例成人完全型直肠脱垂患者,采用直肠乙状结肠部分切除联合直肠固定术进行手术治疗.结果 6例患者全部治愈,术后平均住院时间为13.7 d,随访3～61个月,无复发病例.结论 直肠乙状结肠部分切除联合直肠固定术治...     

吻合器痔上黏膜环形切除术治疗成人直肠黏膜脱垂的疗效初探

目的 为治疗成人直肠黏膜脱垂探寻有效的治疗方法。方法 采用吻合器痔上黏膜环形切除术（PPH），对8例直肠黏膜脱垂患环形切除3-5cm直肠黏膜，治疗后第2，4，12，24周随访。结果 患术后3d内出院，手术时间住院日明显缩短，临床症状基本消失，排便规律，大便粗细正常，肛门自主收缩有力，持久，做排便动作无黏膜脱出，无明显手术并发症。结论 经肛门PPH治疗成人直肠黏膜脱垂，手术操作方法简便，易掌握，使用安全，如操作得当，不会出现严重的并发症，应成为经肛门治疗直肠黏膜脱垂的首选方法。     

Abnormalities of colonic function in patients with rectal prolapse and faecal incontinence

We have investigated changes in colonic motility and anorectal function in 6 continent patients with a rectal prolapse; in 10 incontinent patients with rectal prolapse and in 16 patients with idiopathic faecal incontinence compared with 26 age and sex match controls. A history of incontinence, irrespective of a prolapse, was associated with significantly lower anal squeeze pressures (P less than 0.05), a deficient anorectal angle (P less than 0.05), failure to retain a balloon containing more than 250 cm3 of air in the rectum (P less than 0.01) and increased sigmoid motility (P less than 0.02) compared with controls. By contrast patients with rectal prolapse and no incontinence had normal anal pressures, a normal anorectal angle and normal sigmoid motility, but transit was delayed. These results indicate that abnormal sigmoid motility is commonly associated with faecal incontinence and that slow transit constipation is frequent in patients with rectal prolapse who are continent.     

间断纵行缝扎硬化注射治疗直肠黏膜内脱垂68例临床分析

目的:观察和评价间断纵行缝扎硬化注射治疗直肠黏膜内脱垂的临床疗效。方法:将68例直肠黏膜内脱垂患者随机分成两组,治疗组(36例)采用经间断纵行缝扎硬化注射治疗,对照组(32例)采用单纯硬化注射治疗。并对临床资料进行分析总结。结果:术后3个月随访,治疗组与对照组的症状、体征总得分比较,治疗组均优于对照组。结论:纵行缝扎硬化注射治疗后症状消除快,近远期疗效佳。     

Rectal prolapse and sphincter operations

The surgical management of rectal prolapse and sphincter injuries is complex. These conditions are benign and generally not life-threatening; however they significantly impact on patients’ quality of life. A large number of operations have been described, but often without thorough follow-up or clearly defined outcomes. The challenge for the surgeon is to balance the patient’s symptom severity and quality of life against the risks of surgery, which include making the anal incontinence worse and recurrence of the prolapse.Neuromodulation with sacral nerve stimulation provides good symptom control in up to 75% of selected patients with anal incontinence irrespective of whether there is a sphincter defect or not. Full thickness rectal prolapse is traditionally treated with a perineal operation such as a Delorme’s procedure, but this is associated with a high recurrence rate. Laparoscopic ventral mesh rectopexy is increasingly used to treat rectal prolapse even in the elderly.     

What causes chronic idiopathic perineal pain?

Aim Chronic idiopathic perineal pain is poorly understood. Underlying structural abnormalities have been clinically suspected but rarely demonstrated objectively. The condition has been frequently considered to be a psychological disorder. We aimed to evaluate how commonly a structural explanation for such pain symptoms is present. Method Patients seen in a pelvic floor clinic with severe chronic functional anorectal pain that was classified as chronic idiopathic perineal pain (study group) were prospectively registered in a pelvic floor database and underwent pelvic floor work up (defaecating proctography, anorectal physiology and anal ultrasound +/‐ rectal examination under anaesthetic). A control group was formed by patients with obstructed defaecation, with or without faecal incontinence, with advanced posterior compartment prolapse. Results Of 59 patients with chronic idiopathic perineal pain [80% women; mean age 53 (range, 22–84) years], representing 5% of all pelvic floor presentations, 33 (56%) had chronic idiopathic perineal pain alone and 26 (44%) had chronic idiopathic perineal pain with obstructed defaecation. Thirty‐five (59%) had an underlying high‐grade internal rectal prolapse (73% with chronic idiopathic perineal pain + obstructed defaecation vs 48% with chronic idiopathic perineal pain alone; P < 0.05). Anorectal pain was present in 50% of 543 controls with advanced posterior compartment prolapse. Conclusion High‐grade internal rectal prolapse commonly underlies chronic idiopathic perineal pain, particularly when obstructed defaecation is present. Chronic anorectal pain is a common, under‐recognized subsidiary symptom in patients with advanced posterior compartment prolapse presenting primarily with obstructed defaecation or faecal incontinence.     

自动痔疮套扎术（RPH）在直肠黏膜脱垂中的应用

目的探讨自动痔疮套扎术（RPH）在直肠黏膜脱垂治疗中的应用。方法对85例直肠黏膜脱垂患者行自动痔疮套扎术治疗的临床资料进行分析总结。结果83例治愈（97．6％）,2例好转（2．4％）,有效率100％,无出血、感染等并发症。结论RPH治疗直肠黏膜脱垂疗效可靠,经济安全,操作简便,创伤小,术后恢复快。