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。     

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.     

手术治疗直肠脱垂20例

我们采用直肠黏膜结扎、直肠黏膜下层及肛门周围药物注射、肛门紧缩术结合的方法治疗直肠脱垂20例,取得满意疗效,总结报道如下。 临床资料：本组男13例,女7例;年龄18～65岁;病程3个月至21年。     

肛门紧缩术合并注射术治疗全层直肠脱垂的临床观察

目的探讨肛门紧缩术合并注射术治疗全层直肠脱垂的临床疗效。方法回顾分析我科2006年5月至2010年6月,采用肛门紧缩术合并注射术治疗全层直肠脱垂15例临床资料。结果治愈15例,治愈率100%。术后6个月随访,15例均无复发。结论肛门紧缩术合并注射术治疗全层直肠脱垂有较好的效果,创伤小,实用经济,是全层直肠脱垂的治疗的一条新途径。     

手术治疗直肠脱垂46例

直肠脱垂是肛管、直肠黏膜、直肠全层和部分乙状结肠向下移位脱出肛外的一种疾病，中医称为脱肛或截肠症。我们2001-2008年采用直肠松弛黏膜结扎瘢痕固定加注射术治疗，取得了较好的疗效，报告如下。     

21例成人型直肠脱垂的外科治疗

目的探讨成人型直肠脱垂的外科治疗方法。方法回顾分析我院2002年1月至2006年7月收治的21例成人型直肠脱垂患者的临床资料？结果本组21例患者中6例不完全脱垂患者均采用吻合器粘膜环形切除术治疗，15完全脱垂者采用改良的Well术或加用肛门紧缩术治疗，术后平均随访20个月，手术效果满意，无1例复发。结论吻合器直肠粘膜环形切除术对不完全性直肠脱垂而言是一种较好的手术方式，对一般情况较好的I、Ⅱ度完全性直肠脱垂的中老年患者而言，采用改良的Well术治疗能取得良好的效果，Ⅲ度直肠脱垂患者加用肛门紧缩术能缓解症状，减少复发。     

复合术式治疗直肠脱垂84例

直肠脱垂是指肛管、直肠粘膜、直肠全层和部分乙状结肠向下移位而脱出肛门外,是一种难治性疾病。我们于1981--2009年对84例成人完全性直肠脱垂采用综合术式治疗,效果满意。     

消痔灵注射结合肛门紧缩术治疗完全性直肠脱垂17例

为观察消痔灵注射结合肛门紧缩术治疗完全性直肠脱垂的临床疗效,采用消痔灵注射结合肛门紧缩术治疗完全性直肠脱垂17例。结果显示,治愈15例,好转2例,治愈率为88．2％,有效率100％。17例中12例术后随访2年以上无复发;2例随访1年以上无复发;失访3例。平均住院23d。结果表明,消痔灵注射结合肛门紧缩术治疗完全性直肠脱垂具有疗效好,损伤少,痛苦小,无明显不良反应及并发症和后遗症等优点。     

提肛运动在治疗直肠脱垂中的应用

直肠脱垂是指直肠黏膜、肛管、直肠全层,甚至部分乙状结肠向下移位,脱出肛外的一种疾病。其特点是直肠黏膜及直肠反复脱出肛门外,伴肛门松弛,多见于儿童及老年人。目前治疗直肠脱垂的方法很多,如中药内服、中药熏洗、直肠黏膜下注射术、直肠周围注射术、肛门紧缩术、直肠瘢痕固定术、直肠乙状结肠部分切除术等,提肛运动在直肠脱垂治疗中也有重要应用,现结合1例说明如下。     

直肠脱垂56例治疗体会

直肠脱垂的手术成功率较低,易复发,我们从1992年10月-2003年10月,采用直肠粘膜排列结扎,肛门环缩、直肠周围注射的"三联术"治疗直肠脱垂,取得满意疗效,报告如下.     

Surgery for occult rectal prolapse

OBJECTIVE: An 'occult' rectal prolapse may be diagnosed during investigation of altered bowel habit. It has been suggested that the outcome of surgery for these patients may be associated with results that are inferior to those achieved in patients with overt rectal prolapse. This study compares the results of surgery for 'occult' and overt rectal prolapse in terms of mortality, morbidity and change in bowel habit. PATIENTS AND METHODS: A retrospective review was undertaken of consecutive patients undergoing surgery for rectal prolapse during the decade 1988-98. Resection rectopexy was the treatment of choice except in patients with faecal incontinence who underwent sutured rectopexy. Those patients who were unfit for an abdominal operation were offered a perineal procedure. Outcome measures were mortality, morbidity, prolapse recurrence, constipation and faecal incontinence. Data were retrieved from case note review, clinical assessment, telephone consultation or postal questionnaire. RESULTS: Rectal prolapse surgery was undertaken in 69 patients with an overt prolapse and 74 patients with an 'occult' prolapse. Patients in the 'occult' prolapse group were significantly younger than those with overt prolapse (P = 0.0002). There were significantly more perineal procedures in the overt prolapse group compared with the 'occult' prolapse group (54% vs 5%, P = 0.0001). There were no deaths within 28 days of surgery. Major surgical complications occurred in 5 patients (3.5%). Seven patients (10%) experienced recurrent prolapse. Rectal prolapse surgery reduced the incidence of St. Mark's grade 4 faecal incontinence from 38% to 19% in the overt prolapse group (P = 0.023) and from 49% to 22% in the 'occult' prolapse group (P < 0.001). Following surgery the incidence of constipation increased in the 'occult' group from 39% to 50% but decreased in the overt prolapse group from 42% to 35%. CONCLUSIONS: Surgery for an 'occult' rectal prolapse is unlikely to benefit patients whose principle symptom is constipation. Approximately half of those patients whose 'occult' rectal prolapse is associated with faecal incontinence will have their bowel habit improved by prolapse surgery.     

Delorme手术治疗25例直肠脱垂的疗效分析

目的探讨Delorifle手术在直肠脱垂治疗中的应用。方法回顾性分析2005年3月至2010年6月间4家医院收治的25例行Delorrne手术的完全性直肠脱垂患者的临床资料。结果25例患者中男性9例,女性16例．年龄46。72（平均52）岁。均顺利完成Delorme手术,无围手术期死亡病例。手术时间45～150（平均65）min,术中出血20～200（平均58）ml,住院时间5～14（平均8．5）d。术后7d,1例患者出现吻合口裂开出血,珠网膜下腔麻醉下再次止血缝合：术后发生轻微并发症8例次,1例顽固性疼痛．3例尿潴留,4例粪便嵌塞。随访时间2。6（平均3．5）年,期间复发1例。术后仍有粪便失禁、便秘和出血的比例分别为37．5％（6／16）、45．5％（5／11）和15．4％（2／11）,Wexner失禁评分明显降低（中位数5．0比9．0,P〈0．01）。肛门静息压和最大压榨压较术前明显增加．初始感觉容积和最大耐受容积较术前明显减少（均P〈0．01）。结论Delorme手术安全、易操作,术后肛门直肠功能明显改善,可考虑作为直肠脱垂的首选方法。     

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。     

The injection treatment of rectal prolapse.

The injection of 5% phenol in oil into the rectal submucosa cured persistent rectal prolapse in 91 of 100 young children. This result supports the view that the common form of rectal prolapse in otherwise-healthy children primarily involves the mucosa and the muscular wall is only secondarily involved.     

直肠脱垂的外科治疗进展

直肠脱垂是一种较少见的疾病,一直以来吸引着许多外科医师对其进行研究.目前治疗直肠脱垂的手术有50多种,其中大部分都是几种基本治疗模式的变形,而且依赖于医师对患者解剖上的把握.目前多种疗法综合治疗成为治疗直肠脱垂较为理想的方式.     

Laparoscopic rectopexy for complete rectal prolapse

Background: The purpose of this study was to evaluate the clinical outcome of laparoscopic rectopexy and its effect on anorectal function investigations. Methods: Twelve patients with complete rectal prolapse without constipation underwent laparoscopic rectopexy. Pre- and postoperative evaluation included scoring of incontinence, anorectal manometry, and anal endosonography. Results: No recurrences of rectal prolapse were seen (median follow-up 19 months). Continence improved in eight of nine preoperatively incontinent patients. Two patients had mild constipation after surgery. Median maximum basal pressure measured by anorectal manometry increased from 20 to 25 mmHg (p=0.005) and the rectoanal inhibitory reflex improved in seven patients (p=0.03). Rectal sensitivity did not change significantly. Endosonography showed asymmetry and thickening of the internal anal sphincter and submucosa preoperatively. After surgery the maximum internal anal sphincter thickness decreased from 3.0 mm to 2.6 mm (p=0.02). Conclusions: Laparoscopic rectopexy improved continence in our patients. Anorectal function tests show a partial recovery of the internal anal sphincter. Laparoscopic rectopexy combines the low morbidity of minimal invasive surgery with the good outcome of abdominal rectopexy.Presented at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), Orlando, Florida, USA, 11–14 March 1995     

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。     

改良Gant-Miwa联合肛门环缩手术治疗直肠脱垂31例临床分析

目的评估改良Gant-Miwa联合肛门环缩手术治疗成人完全性直肠脱垂的疗效。方法回顾性分析2005年9月至2012年1月间在杭州市第三人民医院接受改良Gant-Miwa联合肛门环缩手术治疗的3l例成人直肠脱垂患者的临床资料。通过肛管直肠测压和Kirwan分级来评价术后肛门功能。结果31例患者手术顺利,手术时间50-165（平均75）min,术中失血量20-80（平均50）ml。术后直肠脱垂症状均消失,无大出血、肛周脓肿、肛瘘、腹腔感染及泌尿生殖功能障碍等并发症发生及围手术期死亡病例,7例出现尿潴留。术后便秘症状缓解率为61．5％（8／13）,排粪困难缓解率为69．6％（16／23）。术后2个月,28例患者接受肛管直肠测压,结果显示,直肠感觉阈值和直肠最大耐受量较术前明显降低．肛管静息压和肛管收缩压与术前相比无明显改变。术后6个月,30例患者进行肛门功能Kirwan评级,Ⅰ级22例,Ⅱ级8例。术后26例患者接受了平均2．5年的随访,2例直肠脱垂复发。结论改良Gant-Miwa联合肛门环缩术治疗成人完全性直肠脱垂操作简便、创伤小、术后并发症少、复发率较低,对于年老体弱、合并基础疾病、一般情况欠佳以及不愿经腹手术的患者尤为适宜。     

Transanal endorectal approach for the treatment of idiopathic rectal prolapse in children: Experience with the modified Delorme's procedure

Background

Persistent or recurrent idiopathic rectal prolapse in children requires surgical intervention. Several techniques have been used to repair this problem. However, recurrence and complications continue to be a challenge in the management of this condition. Here we report our experience in using the modified Delorme's procedure to treat such patients.

直肠内脱垂的手术疗效分析

目的评价分析直肠内脱垂的手术治疗效果。方法通过对 6 2例直肠内脱垂手术治疗患者的病史回顾和信访调查 ,分析手术疗效和伴随症状的改善情况。结果直肠内脱垂手术有效率为 73% ,其中排便困难、肛门坠胀、便不尽感、手法协助排便及服用泻剂维持排便的有效率分别为77%、80 %、71%、86 %和 97%。结论直肠内脱垂必须经过严格的非手术治疗确认无效后 ,方可考虑外科治疗 ,应严格掌握手术适应证。