Clinical Observation Of Rectocele Repair Plus PPH In The Treatment Of Rectocele

Rectocele,also known as vaginal wall prolapse,is a relatively common disease,more common in women,as one of the important reasons of outlet obstruction constipations.At present,in our country, rectocele in patients is with a low attendance rate.Although there is a large variety of methods of rectocele surgical treatment,but in the overall point of view on postoperation,the symptom of constipation is not mitigated or alleviated,and then it still has a very high relapse rate.Therefore,considering the actual clinical situation,we put forward rectocele surgical indications,and focused on observing the short-term and long-term effect of the rectocele repair surgery plus PPH.Hope that,through clinical observation of this study we can improve the diagnosis of rectocele rate, standardized rectocele surgery indications,improve surgery effect and reduce postoperative relapse rate.1.Rectocele etiology and surgical indications for the rectocele Rectum anterior is supported by the recto-vaginal septum.When the recto-vaginal septum defects or degrades,resulting the supporting organizations function around the rectum and the vagina becoming lower,forming the rectocele risk factors.At this point, if the patient has a long-term constipation and bowel habit,it would lead to increase intra-abdominal pressure,increase rectal pressure, separate the weak tissue,torn fascia,lacerate muscle.In addition, labor abnormalities,such as dystocia,hysteresis,and the birth injury can cause the original damage to the weak recto-vaginal septum. The rectum anterior,when stool after,or increasing pressure within the rectum,go into the vagina forming the vaginal-rectal hernia.Considering the above-mentioned cause of rectocele,we believe that the surgical indications should include some points:(1) A long history,usually more than one year.(2) Severe clinical symptoms, passed a strict medical treatment proved to be ineffective or minor, and has seriously affected the patient's everyday work,study and life.(3) Defecography show that rectocele is deeper than 16 mm,that is,Ⅱ,Ⅲdegree rectocele.(4) Rule out other similar symptoms of constipation.2.The general data and randomizationObserve 58 cases of patients with rectocele.They were all women,aged 35-68 years(median age 48 years).46 cases of maternal were multipara,accounting for 79.31(46/58),producing less than 2, in which there is one person going through dystocia.All patients' history of constipation is between 1-30 years.36 cases are Complicated in varying degrees of anarectal diseases,26 cases of internal hemorrhoids gradeⅡand or rectal prolapse,2 cases of puborectalis spasm,1 cases of pelvic floor muscle spasm syndrome, 10 cases ofⅠdegree internal hemorrhoids.58 patients were divided into 2 groups,28 cases of treatment group,30 cases of the control group.After grouping the two groups had no statistically significant difference(p＞0.05) in average age, history of constipation,Longo Ods score,defecography as well asⅡdegree internal hemorrhoids with or rectal prolapse.Therefore,these 2 groups are randomized.3.Surgical treatmentTreatment groups:Patients take knives.When subarachnoid and epidural block works,conventionally disinfect the perineum and rectum cavity and pave surgery towel.Enlarge the anus slowly to 4 fingers.Completely expose the region of rectocele.Incise along the longitudinal axis of one diamond-shaped area for removal of surplus mucosa and submucosa.Expose on both sides of the separation of the anal levator,intermittent suture on both sides of muscles,followed by suture the mucosa and submucosa.Make clockwise submucosa and mucosa purse suture with 4-0 purse needle,above the dentate lin about 3.0 centimeters and 4.0 centimeters,respectively,at 6 o' clock and 12 o' clock.If they are complicated with rectal prolapse,the space between two purse suture should be wider.Put stapler head to the top of the purse suture,and tighten the purse suture and ligation. Ligate the proximal purse line of the rectum first,and then ligate distal purse line.Put out the purse line through the hole by using the line-side device,hold the line appropriately,make the resection part of mucosal and submucosal area into the stapler,screw the stapler and make it work,at the same time cut off the lower rectal mucosa and submucosa and staple.Hold on the stapler at the closure for more than 30 seconds in order to prevent bleeding.Take out the stapler. Make sure that there is no active bleeding in the surgical region, then put a Vaseline gauze into the anus,operation complete.Control group:patients take knives.When subarachnoid and epidural block works,conventionally disinfect the perineum and rectum cavity and pave surgery towel.Enlarge the anus slowly to 4 fingers.Completely expose the region of rectocele.Make a longitudinal median incision above the dentate line,deep submucosa, length is slightly more than the longitudinal length of rectocele. Expose both sides of the anal and rectal muscle,and intermittently run suture line.Cut off both sides of the redundant rectal mucosa, and then take the continuous mattress suture methods on both sides of the mucosa.Make sure that there is no active bleeding in the surgical region,then put a Vaseline gauze into the anus,operation complete.4.Observation dataRecord target situation first post-operation defecation,after 1 week,1 month,3 months of the bowel,at the same time,Score the short-term and the long-term efficacy of surgery by the use of Longo Ods table.Meantime also observe post-operative complications, postoperative analgesic drug dosage and length of stay in hospital.5.Results(1) Group comparison:2 Groups are all more significant improved compare with preoperative.One month compared with three month,the efficacy has no significant difference between the treatment group, there is significant difference in the control group.(2) Inter-group comparison:Treatment group and control group have no significant difference(p＞0.05) at the post-operation defecation time,the first one week,the first month.At 3 months after the operation there is significant difference between the treatment group and the control group.In the control group there is 1 case bleeding in a 24-hour postoperative,three cases have rectocele recurrence after three months.Other patients are without postoperative complications.There are four cases of patients of the treatment group have moderate analgesic(tramadol) in the first 24 hours post-operation, accounting for 14.29%(4 / 28);the control group 4 cases,accounting for 13.33%(4 / 30).In the treatment group the average length of stay is 8.72 days,as in the control group the average length of stay is 8.95 days.6.Conclusion(1) The procedure can improve the situation of patients with defecation.(2)The procedure more appropriately applies to the treatment of gradeⅡ,Ⅲdegree rectocele patients.Judging from the long-term efficacy of the procedure with lower relapse rates,it is better than transanal rectocele repair.(3)The procedure used in the treatment of rectal prolapse combined with gradeⅡhemorrhoids were to obtain better results.From its long-term effect,it is better than transanal rectocele repair.