發(fā)布時間：2018-05-12 03:45

  本文選題：直腸前突 + 改良STARR術�。� 參考：《吉林大學》2015年碩士論文

【摘要】：目的：旨在探討改良STARR術在治療直腸前突患者時具有的臨床應用效果。 方法：選取我院結(jié)直腸肛門外科2012年10月到2014年6月期間符合研究標準的173例直腸前突患者，分為治療組（90例）和對照組（83例），治療組行改良STARR術，對照組行黏膜肌瓣法（Khubchandani修補法)，進行院內(nèi)和門診隨訪，記錄兩組術式患者在術后1周（手術時間、術中出血量、術后尿潴留、術后便血發(fā)生率、術后肛門明顯疼痛時間、術后ODS評分及住院天數(shù)）的觀察指標和分別評價術后1個月及3個月的臨床療效。進行統(tǒng)計學分析兩組術式比較項目之間的差異。 結(jié)果：選入本臨床研究的173例直腸前突患者均分別順利完成上述兩組術式，術后1周院內(nèi)隨訪，治療組（改良STARR術）在手術時間（15.1±2.1min）、術中出血量（10.8±2.5ml）、術后尿潴留發(fā)生率（8.9%）、術后便血發(fā)生率（13.3%）、術后肛門明顯疼痛時間（1.1±0.3d）、術后臨床癥狀改善程度（ODS評分2.2±0.6）及住院天數(shù)（6.2±0.7d）等近期觀察指標結(jié)果較對照組（黏膜肌瓣法-Khubchandani修補法）的手術時間（17.9±2.4min）、術中出血量（19.6±3.1ml）、術后尿潴留發(fā)生率（20.5%）、術后便血發(fā)生率（27.7%）、術后肛門明顯疼痛時間（2.8±0.5d）、術后臨床癥狀改善程度（ODS評分4.1±0.5）及住院天數(shù)（7.8±0.6d）等指標結(jié)果具有明顯優(yōu)勢，P0.05，，具有統(tǒng)計學意義。另外，對兩組手術方法術后1個月及3個月進行的臨床療效評價（評價標準參照中華醫(yī)學會外科學分會肛腸外科學組制定的《便秘診治暫行標準》）結(jié)果如表3.3所示。經(jīng)統(tǒng)計學分析，治療組的患者在遠期臨床療效評價結(jié)果上也較對照組存在明確優(yōu)勢，P0.05，具有統(tǒng)計學差異。 結(jié)論: 1、本臨床研究中的統(tǒng)計學分析結(jié)果表明應用改良STARR術治療直腸前突的臨床應用效果優(yōu)于黏膜肌瓣法（Khubchandani修補法），同時也符合文獻報道中關于標準STARR術較其他傳統(tǒng)手術方法而言擁有的顯著優(yōu)點，具有療效好、創(chuàng)傷小、并發(fā)癥少、恢復快等臨床應用優(yōu)勢。 2、與標準STARR術相比，改良STARR術具有新的亮點:①以“一針法”精確定位，對直腸前突定位更準。②僅使用一把PPH吻合器，降低治療費用，節(jié)約醫(yī)療資源。③僅需單次的切除與吻合，且切除的深度為超過粘膜下層至肌層而未達直腸壁全層。手術創(chuàng)傷性更小。 本臨床研究表明改良STARR術治療直腸前突具有良好的臨床應用效果。
[Abstract]:Objective: To explore the clinical effect of modified STARR in the treatment of rectocele.
Methods: 173 cases of rectal protrusion in our hospital from October 2012 to June 2014 were selected and divided into the treatment group (90 cases) and the control group (83 cases). The treatment group was treated with modified STARR, and the control group was treated with mucosal muscle flap (Khubchandani repair). The patients were followed up in the hospital and in the outpatient department, and two groups of surgical patients were recorded in the operation. The following 1 weeks (operation time, intraoperative bleeding volume, postoperative urinary retention, postoperative bleeding rate, postoperative anus pain time, postoperative ODS score and the number of days in hospital) were observed and the clinical efficacy of 1 months and 3 months after operation were evaluated respectively. The differences between the two groups were statistically analyzed.
Results: 173 cases of rectal protrusion in this clinical study were successfully completed the above two groups, 1 weeks after the operation in the hospital. The treatment group (modified STARR) was operated on (15.1 + 2.1min), intraoperative bleeding (10.8 + 2.5ml), postoperative urinary retention (8.9%), postoperative incidence of stool (13.3%), and postoperative anus pain (1.1) The postoperative clinical symptom improvement (ODS score 2.2 + 0.6) and the number of hospitalized days (6.2 + 0.7d) were compared with the control group (17.9 + 2.4min) of the control group (17.9 + 2.4min), intraoperative bleeding (19.6 + 3.1ml), postoperative urinary retention (20.5%), postoperative bleeding rate (27.7%), and postoperative anus obvious Pain time (2.8 + 0.5d), postoperative clinical symptoms improvement (ODS score 4.1 + 0.5) and hospitalization days (7.8 + 0.6d) have obvious advantages, P0.05, with statistical significance. In addition, the evaluation of the clinical efficacy of the two groups of surgical methods 1 months and 3 months after the operation of the Chinese Medical Association outside the science branch anorectal. The results of the provisional standard for the diagnosis and treatment of constipation made by the scientific group were shown in table 3.3. By statistical analysis, the patients in the treatment group had a definite advantage over the control group in the outcome of the long-term clinical efficacy, P0.05, with statistical differences.
Conclusion:
1, the results of statistical analysis in this clinical study show that the clinical application of modified STARR in the treatment of protrusion of rectum is better than that of the mucosal muscle flap (Khubchandani repair). It also conforms to the significant advantages of the standard STARR operation compared with other traditional surgical methods, which have good curative effect, small trauma and fewer complications. Quick recovery and other clinical application advantages.
2, compared with the standard STARR, the improved STARR has a new bright spot: (1) the precise location of the "one needle" method and the more accurate location of the protrusion of the rectum. (2) only one PPH stapler is used only to reduce the cost of treatment and save medical resources. Surgery is less traumatic.
This clinical study shows that modified STARR has good clinical effect in the treatment of rectocele.

【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R657.1

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