| 1. Rectocele(RC), also known as prominent rectum wall, as one of the common reasons of outlet obstruction constipations, is usually diagnosed in anus bowel surgery. It occurred more frequently among multipara. So far, an increasing number of patients are diagnosed of rectocele in our country. Although there are many surgical treatments available for rectocele, the symptom of constipation is not mitigated or alleviated postoperatively so there is a very high recurrence rate. Therefore, 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.improve The quality of the patients lives.2. Rectocele etiology and surgical indications for the rectocele.Female anterior rectal wall is supported by the rectovaginal septum.which is mainly composed of fascia pelvis,the inner part of the septum is levator ani muscle from the midline crossing fibers.In view of the rectal wall is weak, coupled with long-term oppression of feces in the defecation, or birth trauma (especially for the multipra), the relaxation of rectovaginal septum, protruding to the vagina results in constipation. Constipation and tenesmus are main prominent symptoms of the disease. The disease is associated with the regional development and long-term adverse bowel habits; male sporadic, more common in surgical removal of the prostate.Therefore, we summarize the indications for surgery should include the following:(1) a history of longer than half a year, six months after conservative treatment with no significant improvement of the symptoms, even those who deteriorate. (2)constipation,obstruction of the anus, anus and perineum bulge, poor stool and other clinical symptoms were. Constipation seriously affects life, strong demand surgical treatment form the patients. (3) defecography showed rectocele II, III degree, which is complicated with a set of overlapping and rectal mucosa in patients with hemorrhoids (4) preoperative routine examination and laboratory examinations rule out serious cardiovascular disease, intestinal organic disease and other diseases.3. The general data and randomizationObserve 62 cases of patients with rectocele. They were all women, aged 37-65 years (median age 45 years).55 cases of maternal were multipara, accounting for 88.71 (55/62).All patients'history of constipation is between 0.5-25 years.62 patients were divided into 2 groups,31 cases of treatment group,31 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 as II degree internal hemorrhoids with or rectal prolapse. Therefore, these 2 groups are randomized.4. Surgical treatmentTreatment groups:Patients were placed in lithotomy position under combined spinal-epidural anesthesia, after the commencement of anesthesia, routine disinfection of the operative field and the vaginal cavity, rectal cavity, and display drapes. Under anesthesia rectal examination, confirmed that no occupying lesions, expand the anal to 3 index fingers slowing for 5mins. The anal dilator (CAD33) coated with a little lubricant were inserted into the anal canal, avoid violence, and remove the bolt, at about 3 cm from the anal margin of perianal skin, the device was sutured at 3,6,9,12 point of the anal. Fully exposing operative field, inserted the Index finger into the vagina,pressed the anterior capsule of the rectocele to the rectum,clamping the protrusion from the weak zone mucosausing allis tissue forceps, using the great curved forceps grip rectal mucosa longitudinally in the range of tooth protrusion2.5cm above the straight line, continuous suture under the curved forceps with a 3-0 catgut deep into muscle, removed forceps after the suture, ligature knot, suture closure to make sure the mucous membrane is in the shape of tower, wide at the bottom and narrow at the top, preventing the formation of artificial rectal mucosal flap. Using small round needle with a 3-0 VICRYL, suture at dentate line at about 3.0 cm and 4.0 cm,3 and 9 o'clock of the line, making the mucosa and submucosa double ring suture, the distance between the double purse was 0.5-1cm, pulling line at 3,9 points, rectal anastomat will be stapled into the top pocket stitching to tighten the purse suture, pay attention to proximal ligation of rectal purse line firstly, and then ligated distal purse line. Using thread (ST 100) pulled the VICRYL from both sides of the anastomat,using haemostat hold purse line to maintain a certain tension, after confirming removal of mucosa into the stapler, at this time put the index finger in the vagina to confirm that the vaginal mucous membrane is not brought into the stapling range, and quickly tighten the stapler firing for more than 30 seconds in order to prevent anastomotic bleeding. Retrograde rotation stapler 3 and a half, carefully observing mucosal resection anastomosis is complete, check whether there is active anastomotic bleeding, if there was bleeding, "8" suture to stop bleeding with absorbable suture. Make sure the surgical field is has no active bleeding, then wrap the drain tube with oil package, inserted the tube into the anus, drainage tube above the proximal anastomosis in order to observe the bleeding, inventory of equipment, completion of surgery.Control group:Patients were placed in lithotomy position under combined spinal-epidural anesthesia, after the commencement of anesthesia, routine disinfection of the operative field and the vaginal cavity, retal cavity, and display drapes. Under anesthesia rectal examination, confirmed that no occupying lesions, expand the anal to 3 index fingers slowing for 5mins. The anal dilator (CAD33) coated with a little lubricant were inserted into the anal canal, avoid violence, and remove the bolt, at about 3 cm from the anal margin of perianal skin, the device was sutured at 3.6.9,12 point of the anal. Fully exposing operative field, inserted the Index finger into the vagina,pressed the anterior capsule of the rectocele to the rectum, clamping the protrusion from the weak zone mucosausing allis tissue forceps, using the great curved forceps grip rectal mucosa longitudinally in the range of tooth protrusion2.5cm above the straight line, continuous suture under the curved forceps with a 3-0 catgut deep into muscle, removed forceps after the suture, ligature knot, suture closure to make sure the mucous membrane is in the shape of tower, wide at the bottom and narrow at the top, preventing the formation of artificial rectal mucosal flap. Make sure the surgical field is has no active bleeding, then wrap the drain tube with oil package, inserted the tube into the anus, drainage tube above the proximal anastomosis in order to observe the bleeding, inventory of equipment, completion of surgery.5. 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. At the same time also observe the complications, and length of stay in hospital.6. Results(1) Group comparison:2 Groups are all more significant improved compare with the 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 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 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.7. Conclusion (1) The procedure can improve the situation of patients with defecation.(2)The procedure more appropriately applies to the treatment of gradeâ…¡. Judging from the long-term efficacy of the procedure with lower relapse rates, it is better than Columnar Suture (Block)(3)The procedure used in the treatment of rectal prolapse combined with hemorrhoids and rectum prolapse were to obtain better results. |
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