CAJ | 학술논문

目的：探讨直肠黏膜柱状缝扎加耻直肌挂线术治疗直肠黏膜内脱垂型便秘的治疗效果和应用价值。方法：选择直肠黏膜内脱垂型便秘患者75例，分为3组，以直肠黏膜柱状缝扎加耻直肌挂线术为治疗组；直肠黏膜点状结扎法为对照组a；单纯直肠黏膜柱状缝扎为对照组b；各25例。接受上述治疗，观察治疗前后主要症状、体征和辅助检查结果的变化情况并评定治疗效果。结果：治疗组术后及3月后随访积分与对照组a、对照组b比较有显著性差异（P＜0.01），疗效优于对照组。随访积分对照组a VS对照组b无明显差异（P>0.05）。对照组a术后有1例无效，对照组b有1例3月后复发。结论：该术式去除了直肠梗阻因素，恢复了直肠的正常生理功能，同时挂线异物刺激局部牵拉自主神经，有助于盆底反射功能恢复，使患者排便通畅。该疗法临床疗效良好，相比传统术式具有疗效好的优点，在严格掌握手术适应症的前提下，可作为直肠黏膜内脱垂所致出口梗阻型便秘较优的手术治疗方案。
목적：탐토직장점막주상봉찰가치직기괘선술치료직장점막내탈수형편비적치료효과화응용개치。방법：선택직장점막내탈수형편비환자75례，분위3조，이직장점막주상봉찰가치직기괘선술위치료조；직장점막점상결찰법위대조조a；단순직장점막주상봉찰위대조조b；각25례。접수상술치료，관찰치료전후주요증상、체정화보조검사결과적변화정황병평정치료효과。결과：치료조술후급3월후수방적분여대조조a、대조조b비교유현저성차이（P＜0.01），료효우우대조조。수방적분대조조a VS대조조b무명현차이（P>0.05）。대조조a술후유1례무효，대조조b유1례3월후복발。결론：해술식거제료직장경조인소，회복료직장적정상생리공능，동시괘선이물자격국부견랍자주신경，유조우분저반사공능회복，사환자배편통창。해요법림상료효량호，상비전통술식구유료효호적우점，재엄격장악수술괄응증적전제하，가작위직장점막내탈수소치출구경조형편비교우적수술치료방안。
Objective:To investigate the efficacy and clinical value of longitudinal suture of mucous membrane of rectum and seton in puborectalis in the treatment of internal rectal mucosa prolapse (IRMP) type constipation. Method:75 cases with IRMP type constipation were divided into 3 groups, a treatment group treated with longitudinal suture of mucous membrane of rectum and seton in puborectalis, a control group a treated with punctiform ligation of mucous membrane of rectum and a control group b treated with longitudinal suture of mucosa membrane of rectum, 25 cases respectively. All cases were treated with the above therapies. The changes of symptoms, signs and auxiliary examination before and after the treatment were observed and analyzed respectively. Results:The therapeutic effect of treatment group is better than control group .The symptoms, signs and auxiliary examination has significant difference vs control group a and control group b after treatment (P<0.01). 3 months later, there is no obvious difference between control group a vs control group b(P>0.05). There is one ineffectual case of control group a after treatment, and one case of control b recurred after three months. Conclusion:The surgical operation eliminates obstruction factors, the vicious circulation caused by the prolapsed mucosa stopped. Meanwhile, the method of seton stimulates autonomic nerve and conduces to recovery of plevic floor’s function ,the patient's defecation no longer obstructed. The clinical curative effect is good, better than other traditional methods. In strict indication of the premise ,this surgical treatment can be chosen as the good treatment of internal rectal mucosa prolapse caused the obstruction of the export infarction constipation.