不同术式治疗直肠黏膜脱垂的对比研究

A comparative study of three surgical methods for treatment of rectal mucosal prolapse

摘要:

目的 比较吻合器痔上黏膜选择性切除术（TST）、内痔自动套扎术（ALH）和直肠黏膜柱状结扎 术（RMCL）3 种手术方式治疗直肠黏膜脱垂的临床效果及安全性。方法 回顾性分析2013 年1 月-2016 年4 月 该院住院治疗的的138 例直肠黏膜脱垂患者的临床资料，根据手术方式分为TST 组、ALH 组和RMCL 组， 比较3 组患者的临床疗效和并发症的发生情况。结果 ① 3 组术后1、2、3 及4 d 的疼痛评分比较，3 组患者不 同时间点的VAS 评分有差异（P <0.05）；3 组患者静息状态下VAS 评分有差异（P <0.05），TST 组和ALH 组 的VAS 评分相比RMCL 组较低，患者疼痛程度较轻；3 组患者VAS 评分变化趋势无差异（P >0.05）。② 3 组患 者的手术时间、住院时间、术中出血量和住院费用比较，差异有统计学意义（P <0.05）；TST 组和ALH 组的手术 时间、住院时间、术中出血量和住院时间比较，差异无统计学意义（P >0.05）。③ TST 组、ALH 组和RMCL 组术后并发症的发生率为14.5%（8/55）、19.6%（9/46）和48.6%（18/37），TST 组和ALH 组术后并发症的发 生率均低于RMCL 组，差异有统计学意义（P <0.05），而TST 组和ALH 组术后并发症发生率的差异无统计 学意义（P >0.05）。④ TST 组、ALH 组和RMCL 组直肠黏膜脱垂的显效率分别为94.5%、95.7% 和70.2%。 TST 组和ALH 组的显效率均高于RMCL 组，差异有统计学意义（P <0.05），而TST 组和ALH 组的显效率比 较，差异无统计学意义（P >0.05）。结论 TST 术和ALH 术均可用于直肠黏膜脱垂的治疗，其近期疗效确切，具 有手术时间短、术中出血少、疼痛程度轻、并发症少的特点，值得推广应用。

Abstract:

Objective To compare the clinical efficacy and safety of three kinds of surgery including tissueselecting therapy stapler (TST), automatic ligation of hemorrhoids (ALH) and rectal mucosa columnar ligation (RMCL) in the treatment of rectal mucosal prolapse. Methods The clinical data of 138 patients of rectal mucosal prolapse admitted in our hospital from January 2013 to April 2016, who underwent TST, ALH or RMCL, were analyzed retrospectively. Their clinical curative effect and complications were compared. Results In comparison of pain score of the TST group, the ALH group and the RMCL group on the 1st, 2nd, 3rd and 4th d after operation, there were differences in the VAS scores of the three groups at different time points (P < 0.05). There were differences in the VAS scores in resting state among the three groups, the VAS scores were lower and the pain was milder in the TST group and the ALH group than in the RMCL group (P < 0.05). The change trend of the VAS scores had no difference among the three groups (P > 0.05). There were significant differences in the operative time, the hospitalization time,the intraoperative blood loss and the hospitalization expenses between the TST group and the RMCL group, the ALH group and the RMCL group (P < 0.05). There was no significant difference in the operation time, the time of hospitalization, the amount of intraoperative bleeding or the hospitalization expenses between the TST group and the ALH group (P > 0.05). The overall incidence of postoperative complications in the TST, ALH and RMCL groups were 14.5% (8/55), 19.6% (9/46) and 48.6% (18/37), respectively; the incidences of complications in the TST and ALH groups were lower than that in the RMCL group (P < 0.05), while there was no significant difference between the TST group and the ALH group (P > 0.05). The effective rates of TST, ALH and RMCL for the treatment of rectal prolapse were 94.5%, 95.7% and 70.2%, respectively; the effective rates of the TST and ALH groups were higher than that of the RMCL group (P < 0.05), but there was no significant difference between the TST group and the ALH group (P > 0.05). Conclusions TST and ALH can be used for the treatment of rectal mucosal prolapse. Their recent curative effect is exact, with short operation time, little bleeding, mild pain and few complications. They are worthy of popularization and application.