手术治疗重度直肠脱垂伴有盆底疝7例

完全性直肠脱垂严重影响患者的生活质量,唯一治疗的方法是外科手术。我院采用直肠周围消痔灵注射疗法,效果显著。但仍有部分病例先后复发,结合检查发现多数伴有盆底疝。2010年7月—2013年4月,我们采用经腹补片修补结合直肠悬吊固定治疗7例消痔灵注射后复发者,收到满意的效果。     

结肠慢传输盆底疝和直肠前突所致顽固性便秘的手术治疗

目的　探讨手术治疗便秘的术式。方法　对 49例结肠慢传输 /或盆底疝合并直肠前突引起便秘的病例 ,采用经腹和阴道联合手术治疗 ,分别切除病变的结肠 /或修补盆底及经阴道修补直肠前突。结果　全组痊愈 38例 (77.5 5 % ) ,显效 8例 (16 .32 % ) ,好转 2例 (4 .0 8% ) ,无效 1例(2 .0 4% ) ,总有效率 (97.96 % )。结论　经腹和阴道联合手术治疗结肠慢传输盆底疝和直肠前突所致顽固性便秘安全有效 ,是一种较好的可供选择的手术方法     

直肠内脱垂合并盆底疝的影像学诊断

目的评价盆腔造影结合排粪造影对直肠内脱垂合并盆底疝的诊断价值。方法回顾性分析120例直肠内脱垂合并盆底疝患者的影像学表现,观察直肠型盆底疝和不含直肠型盆底疝的其他类型疝合并直肠内脱垂的类型。结果盆腔造影结合排粪造影片上,120例盆底疝有直肠型56例、间隔型27例、阴道型12例和混合型25例,而混合型中有18例直肠型盆底疝。分组结果显示,74例直肠型盆底疝均合并全层直肠套叠,盆底疝疝囊位于套叠的直肠壁环形浆膜囊袋内;46例不含直肠型盆底疝的其他类型疝均不合并全层直肠套叠。结论盆腔造影结合排粪造影能准确诊断各型盆底疝,由于直肠型盆底疝与全层直肠套叠合并出现,因此,盆腔造影结合排粪造影也能准确区分全层直肠套叠与直肠黏膜脱垂。     

11例直肠内脱垂伴盆底疝外科治疗分析

目的：探讨出口梗阻性便秘常见病因之直肠内脱垂伴盆底疝的手术治疗效果。方法：搜集我院近年手术治疗的11例直肠内脱垂伴盆底疝患者的临床资料,分析春病例特点,手术方式及疗效。结果：11例患者中9例（占82％）,术后1周,症状立即缓解,2例经术后配合功能锻炼3个月症亦缓解消失,结论：功能性直肠悬吊术,附加盆疝修补术,盆底抬高,子宫固定,乙状结肠（部分）切除术是治疗直肠内脱垂伴盆底疝的有效方法。     

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。     

直肠前突并发直肠黏膜内脱垂致便秘100例治疗观察

近 2年 ,我们通过直肠镜检 ,肛门指诊和排粪造影等检查 ,对已婚生育中青年女性 1 0 0例直肠前突并发直肠黏膜内脱垂 ,所致的出口梗阻性便秘患者行直肠前突 ,直肠黏膜内脱垂注射术 ,取得较满意效果 ,现总结如下。1　临床资料1 .1　一般资料 :本组均为已婚经产妇。年龄 30～ 40岁 2 3例 ,41～ 5 0岁 42例 ,5 1～ 60岁 35例 ,病程为 2～ 6年。经保守治疗无效 ,均须依赖服泻药或灌肠排便。主要临床表现 [1]特点为排干稀便均困难 ,排便时间明显延长 ( >1 5 min) ,排便不尽感 ,便条变细 ,肛门坠胀 ,甚至用手助便等症状。1 .2　检查方法1 .2 .1　食…     

51例直肠内脱垂手术疗效的观察

目的：评价分析直肠内脱垂的手术疗效。方法：通过对51例直肠内脱垂手术治疗患者临床资料的回顾和信访调查，分析其手术疗效和们随症状的改善情况。结果：51例直肠内脱垂手术有效率为72．5％，其中对排便困难，肛门坠胀，便不尽感，便血，骶尾部疼痛，手法协助排便及服用泻剂维持便症状的有效率分别为69．8％，70．7％，78．9％，100％，50％，80．0％和87．5％，结论：直肠内脱垂必须经过严格的非手术治疗，无效后方可考虑外科治疗，应从严掌握适应证。     

PPH治疗直肠内脱垂型便秘的体会

目的 评估PPH 技术治疗直肠黏膜内脱垂引起的排便障碍的疗效.方法 回顾性分析我院2005年1月至2008年1月经PPH手术治疗的直肠黏膜内脱垂300例临床资料. 结果 291例(97%)患者一次PPH手术后排便障碍得到了缓解;9例(3%)症状缓解不明显,其中6例行2次PPH手术,术后排便障碍缓解.结论 PPH治疗因直肠黏膜内脱垂引起的排便障碍是一种安全、有效、快速的微创治疗方法.     

折叠缝扎注射术治疗直肠黏膜内脱垂型便秘

目的：探讨高位折叠低位缝扎加注射术治疗直肠黏膜内脱垂型便秘的临床疗效。方法：采用高位折叠低位缝扎加注射术治疗直肠黏膜内脱垂型便秘15例,随访6个月至1年。结果：15例中治愈9例,显效3例,好转2例,无效1例,总有效率93.3%。结论：高位折叠低位缝扎加注射术治疗直肠黏膜内脱垂型便秘,临床疗效肯定,并发症少。     

PPH治疗直肠黏膜内脱垂的疗效分析

目的:分析评价PPH在治疗直肠黏膜内脱垂方面的近、远期疗效和并发症发生情况.方法:2002年6月至2006年8月分别采用PPH和传统手术治疗直肠黏膜内脱垂患者共计160例,随访6个月到4年不等.结果:160例患者均痊愈,无严重的近、远期并发症发生.而且两种手术方法在治疗效果方面比较没有明显的差别.结论:PPH在治疗直肠黏膜内脱垂方面和传统手术相比并不具有优越性.     

盆底松弛直肠脱垂的微创治疗

目的探讨直肠黏膜脱垂及直肠前突导致排便障碍的微创治疗方法。方法回顾性分析我院2003年12月-2005年12月收治的直肠黏膜脱垂、直肠黏膜脱垂合并直肠前突及单纯直肠前突共200例的临床资料。结果本组有194例（97％）行一次直肠黏膜环形切除（PPH）手术后排便障碍得到了缓解;有6例（3．0％）症状缓解不明显,其中,行2次PPH手术者4例,术后排便障碍缓解。结论PPH手术在治疗时恢复了肛管的通畅性,安全、迅速,住院时间短,恢复快,相对传统术式复发少,对于重度脱垂的病人可重复手术,效果好。     

特发性慢转运型便秘的诊断与外科治疗

目的 探讨便秘的病因,建立诊断及治疗方法。方法 对正常人及一组自然便次减少、便意缺乏的患者进行对照研究,详细记录患者病史,并对患者进行肠道运转、肛肠动力学、盆底电生理及排粪造影检查。对保守治疗无效的患者行结肠次全或全切除术,标本作病理检查。结果 与对照组相比,患者组自然便次减少;肠道转运时间延长;直肠感觉功能降低;模拟排便时盆底肌抑制能力下降。部分患者伴盆腔脏器松驰。病理检查结果显示结肠神经丛细胞     

Long-term outcome after laparoscopic and open surgery for rectal prolapse

Background Laparoscopic repair (LR) of rectal prolapse is potentially associated with earlier recovery and lower perioperative morbidity, as compared with open transabdominal repair (OR). Data on the long-term recurrence rate and functional outcome are limited. Methods Perioperative data on rectal prolapse in relation to all LRs performed between December 1991 and April 2004 were prospectively collected. The LR patients were matched by age, gender, and procedure type with OR patients who underwent surgery during the same period. Patients with previous complex abdominal surgery or a body mass index exceeding 40 were excluded from the study. Data on recurrence rate, bowel habits, continence, and satisfaction scores were collected using a telephone survey. Results A total of 111 patients (age, 56.8 ± 18.1 years; female, 87%) underwent attempted LR. An operative complication deferred repair in two cases. Among the 111 patients, 42 had posterior mesh fixation, and 67 had sutured rectopexy (32 patients with sigmoid colectomy for constipation). Eight patients (7.2%) had conversion to laparotomy. Matching was established for 86 patients. The LR patients had a shorter hospital stay (mean, 3.9 vs 6.0 days; p < 0.0001). The 30-day reoperation and readmission rates were similar for the two groups. The rates for recurrence requiring surgery were 9.3% for LR and 4.7% for OR (p = 0.39) during a mean follow-up period of 59 months. An additional seven patients in each group reported possible recurrence by telephone. Postoperatively, 35% of the LR patients and 53% of the OR patients experienced constipation (p = 0.09). Constipation was improved in 74% of the LR patients and 54% of the OR patients, and worsened, respectively, in 3% and 17% (p = 0.037). The postoperative incontinence rates were 30% for LR and 33% for OR (p = 0.83). Continence was improved in 48% of the LR patients and 35% of the OR patients, and worsened, respectively, in 9% and 18% (p = 0.22). The mean satisfaction rates for surgery (on a scale of 0 to10) were 7.3 for the LR patients and 8.1 for the OR patients (p = 0.17). Conclusions The hospital stay is shorter for LR than for OR. Both functional results and recurrent full-thickness rectal prolapse were similar for LR and OR during a mean follow-up period of 5 years.     

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目的 探讨结肠慢传输型便秘的诊断及治疗方法，提高诊治水平。方法 对部分顽固性便秘病人的临床症状，结肠软内镜检查，结肠传输试验和排粪造影等的检查结果进行分析，对52例确诊为结肠慢传输型便秘者，进行了手术治疗。其中全结肠切除，回肠与直肠吻合术14例，次全结肠切除，盲肠与直肠吻合术34例，左半结肠切除4例。结果 结肠慢传输型便秘的病理检查可肠壁神经丛有变性，减少，回直肠吻合术后病人大便次数偏多，多数＞3次／日，个别病人半年内每天大便20次左右，半年后次数逐渐减少。左半结肠切除术后仍有排粪困难；而盲直肠吻合术效果较好，多数病人大便1－3次／日。结论 结肠慢传输型便秘的病人行次全结肠切除，盲直肠吻合术效果较好。     

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.     

盆底松弛综合征的病理生理与外科治疗的研究

目的研究盆底松弛综合征（ＲＰＦＳ）的病理生理特征，并探讨盆腔紧固术对本征的治疗价值。方法对１１例诊断为ＲＰＦＳ患者的临床症状进行了分析，并行标准化盆腔紧固术，术后平均随访１９个月。结果患者的主要症状与体征为排便困难、排便不全、会阴坠胀、排便时会阴下凸、子宫后倾及直肠松弛。肛肠动力学检测有静息压、收缩压下降，收缩时间缩短，直肠感觉功能减退。排粪造影示盆腔多种松弛性病变同时存在。术中可见结肠、直肠、子宫的固定松弛及腹腔位置降低。术后７例症状完全消失；４例明显改善。结论ＲＰＦＳ的病理生理特征是以盆腔脏器为主的多部位、多系统、多脏器松弛性改变。盆腔紧固手术对本征的治疗具有一定价值     

Laparoscopic ventral rectopexy for external rectal prolapse improves constipation and avoids de novo constipation

Objective Abdominal rectopexy is ideal for otherwise healthy patients with rectal prolapse because of low recurrence, yet after posterior rectopexy, half of the patients complain of severe constipation. Resection mitigates this dysfunction but risks a pelvic anastomosis. The novel nerve‐sparing ventral rectopexy appears to avoid postero‐lateral rectal dissection denervation and thus postoperative constipation. We aimed to evaluate our functional results with laparoscopic ventral rectopexy. Method Consecutive rectal prolapse patients undergoing laparoscopic ventral rectopexy were prospectively assessed (Wexner Constipation and Faecal Incontinence Severity Index scores) pre‐, 3 months postoperatively, and late (> 12 months). Results Sixty‐five consecutive patients with external rectal prolapse (median age 72 years, 34% > 80 years, median follow up 19 months) underwent laparoscopic ventral rectopexy. There was one recurrence (2%) and one conversion. Morbidity (17%) and mortality (0%) were low. Median operating time was 140 min and median length of stay 2 days. At 3 months, constipation was improved in 72% and  mildly induced in 2% (median pre‐and postoperative Wexner scores 9 vs 4, P < 0.0001). Continence was improved in 83% and mild incontinence was induced or  worsened in 5% (median pre‐ and postoperative incontinence score 40 vs 4, P < 0.0001). Significant improvement in both constipation and incontinence (P < 0.0001) remained at median 24 months late follow‐up. Conclusion Ventral rectopexy has a recurrent prolapse rate of < 5%, similar to that of posterior rectopexy. Its correction of preoperative constipation and avoidance of de novo constipation appear superior to historical functional results of posterior rectopexy. A laparoscopic approach allows low morbidity and short hospital stay, even in those patients over 80 years of age in whom a perineal approach is usually preferred for safety.     

Evaluation and surgical treatment of rectal prolapse: an international survey

Aim Validated guidelines for the surgical and non‐surgical treatment of rectal prolapse (RP) do not exist. The aim of this international questionnaire survey was to provide an overview of the evaluation, follow‐up and treatment of patients with an internal or external RP. Method A 36‐question questionnaire in English about the evaluation, treatment and follow‐up of patients with RP was distributed amongst surgeons attending the congresses of the European Association for Endoscopic Surgery and the European Society of Coloproctology in 2010. It was subsequently sent to all the members of the American Society of Colon and Rectal Surgeons and the European Society of Coloproctology by e‐mail. Results In all, 391 surgeons in 50 different countries completed the questionnaire. Evaluation, surgical treatment and follow‐up of patients with RP differed considerably. For healthy patients with an external RP, laparoscopic ventral rectopexy was the most popular treatment in Europe, whereas laparoscopic resection rectopexy was favoured in North America. There was consensus only on frail and/or elderly patients with an external prolapse, with a preference for a perineal technique. After failure of conservative therapy, internal RP was mostly treated by laparoscopic resection rectopexy in North America. In Europe, laparoscopic ventral rectopexy and stapled transanal rectal resection were the most popular techniques for these patients. Conclusion The treatment of RP differs between surgeons, countries and regions. Guidelines are lacking. Prospective comparative studies are warranted that may result in universally accepted protocols.