单吻合器行经肛门直肠膨出修补和直肠黏膜切除术治疗排便障碍综合征的临床疗效观察_West China Medical Journal

Authors：

 万伯顺 ¹ , 陈跃宇 ¹ , 杨伟强 ¹ , 叶光耀 ² , 钟鸣 ²

1. ;
2. ;

Corresponding author：

Keywords：

便秘; 排便障碍综合征; 直肠前突; 吻合器

DOI：

10.7507/1002-0179.20150425

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目的对由于直肠前突引起的排便障碍综合征患者使用单吻合器行经肛门直肠膨出修补和直肠黏膜切除，并行术前、术后临床症状和功能评估，评价该方法的手术效果。方法 2010年8月-2013年12月对39例患有直肠前突经过至少4个月的保守治疗未见明显好转的女性患者采取单吻合器行经肛门直肠膨出修补和直肠黏膜切除术（TRREMS）治疗，并观察手术效果、并发症及复发率。结果平均手术时间为（40.00±3.78）min，术中平均出血量（15.00±5.01）mL，全部患者术后住院观察24 h，均未见明显早期并发症，经随访12～24个月，3例出现手术相关并发症（7.69%），1例吻合口狭窄（2.56%），经扩肛治疗后，症状缓解，能自行排气排便，2例出现肛门周围疼痛不适（5.13%），疼痛评分3级，予以肛周局部外用药物治疗后疼痛缓解。术后排粪造影显示共4例（10.26%）存在直肠前突残留（均为Ⅰ级）。全部患者术后未出现出血、直肠阴道瘘、性交痛等并发症。结论 TRREMS手术治疗直肠前突引起的排便障碍综合征无论在解剖学上还是在功能评价上都是安全有效的，且术后并发症少，术后疼痛轻。

Citation： 万伯顺, 陈跃宇, 杨伟强, 叶光耀, 钟鸣. 单吻合器行经肛门直肠膨出修补和直肠黏膜切除术治疗排便障碍综合征的临床疗效观察. West China Medical Journal, 2015, 30(8): 1488-1490. doi: 10.7507/1002-0179.20150425 Copy

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1. Zbar AP, Lienemann A, Fritsch H, et al. Rectocele:pathogenesis and surgical management[J]. Int J Colorectal Dis, 2003, 18(5):369-384.
2. 王国强, 刘扬, 刘青, 等. 吻合器痔上黏膜环切术的近远期疗效及安全性的Meta分析[J]. 中华外科杂志, 2013, 51(11):1034-1038.
3. Jorge JM, Wexner SD. Etiology and management of fecal incontinence[J]. Dis Colon Rectum, 1993, 36(1):77-97.
4. Jayne DG, Schwandner O, Stuto A. Stapled transanal rectal resection for obstructed defecation syndrome:one-year results of the European STARR Registry[J]. Dis Colon Rectum, 2009, 52(7): 1205-1212; discussion 1212-1214.
5. Mirabi N, Fazlani M, Raisee R. Comparing the outcomes of stapled transanal rectal resection, delorme operation and electrotherapy methods used for the treatment of obstructive defecation syndrome[J]. Iran J Med Sci, 2014, 39(5):440-445.
6. Jiang C, Ding Z, Wang M, et al. A transanal procedure using an endoscopic linear stapler for obstructed defecation syndrome:the first Chinese experience[J]. Tech Coloproctol, 2012, 16(1):21-27.
7. Leal VM, Regadas FS, Regadas SM, et al. Clinical and functional evaluation of patients with rectocele and mucosal prolapse treated with transanal repair of rectocele and rectal mucosectomy with a single circular stapler (TRREMS)[J]. Tech Coloproctol, 2010, 14(4):329-335.
8. Cruz JV, Regadas FS, Murad-Regadas SM, et al. TRREMS procedure (transanal repair of rectocele and rectal mucosectomy with one circular stapler):a prospective multicenter trial[J]. Arq Gastroenterol, 2011, 48(1):3-7.

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单吻合器行经肛门直肠膨出修补和直肠黏膜切除术治疗排便障碍综合征的临床疗效观察

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