A Long Line Of Strong Points Hanging Treatment Puborectalis Syndrome Clinical Study

Puborectalis syndrome is a form of spastic puborectalis hypertrophy, leading to pelvic floor outlet obstruction is characterized by disorders of the bowel is the principal cause of outlet obstruction constipation a common factor. The long-term efficacy of conservative treatment such as taking laxatives poor, and more side effects are becoming increasingly common surgical treatment is applied to the clinical, surgical method to use more full-beam part of the puborectalis resection surgery to cut off due to puborectalis muscle How many can not be defined, which affected the results of operations, efficacy significantly different, higher rate of recurrence, and to varying degrees, bring about some complications, complications. At present, the Chinese External: The strong points hanging long-line method achieved good efficacy, but did not form a unified theoretical system, technical operations has not been standardized. Therefore, from the traditional hang-line therapy begin to explore the puborectalis syndrome, surgical treatment, and regulation of long hung up with the strong points of the operation of traditional Chinese medicine Oral therapy has important clinical significance.Objective: Strong points by the use of long-line method and the use of hanging puborectalis part of the whole bundle resection of contrast, evaluation of long-line method of hanging strong points puborectalis syndrome patients with constipation due to efficacy, anal function and infection and other complications the impact of strong points to confirm a long hang-line method to treat constipation caused by puborectalis syndrome, a simple, effective and safe surgical approach and this method to provide scientific basis for the clinical and theoretical, regulate their operation. Methods: This study met the inclusion criteria were selected puborectalis syndrome, 60 patients were randomly divided into two groups, long-line method hanging strong points (treatment group) and the puborectalis part of the whole bundle resection group (control group), each of 30 cases. 60 patients underwent routine preoperative examination and preparation. The treatment group president of Strong Point hang-line method: In patients under spinal anesthesia to take lateral position, in front of the coccyx tip is about 0.5cm (the equivalent of the coccyx tip and connected to the midpoint of the anus), Office of strong points to take a long, with scalpel from the Qiang caves to the anal margin of the direction of incision to the skin and subcutaneous tissue near the dentate line, with ball-end probe (other side of the line silk with a thick rubber band) from a long strong points across to the anal part of the puborectalis muscle and some internal anal sphincter (about to hang up the whole bundle puborectalis 2 / 3, including some within the sphincter) into the probe from the rectum falling, and leads to a rubber band, rubber band taut, and the ligation of [1], after 10 days about rubber band off and began expanding anus, 1 ~ 2 times a week, continuous treatment until January. Control group were full-beam part of the puborectalis resection: Take the coccyx under the incision, approximately 3 ~ 4cm, cut the skin, subcutaneous tissue. His left index finger into anal guide, palpable, and the middle position after the puborectalis hypertrophy, right hand holding the forceps in the puborectalis curved and straight wall of separation between puborectalis lower edge, and bend with two from the free ends of the respective clamp folders take Puborectalis about 1.5 ~ 2cm, in the vascular clamp inside the folder to take the puborectalis resection (check the width of the clip is about the width of the puborectalis 1 / 2), bleeding stump ligation. Place rubber band drainage, suture subcutaneous tissue and skin [2]. Other treatments as a routine treatment. Respectively, before and after treatment 30 days after treatment were observed 60 days postoperative efficacy (the degree of difficulty defecation, defecation frequency, defecation time, stool, and whether or abdominal distension, abdominal pain, symptoms and other major changes in the anus bulge), quantitative score to assess the two-term and long-term treatment effects; and observe the anal function, the recurrence rate and post-operative complications (pain, with or without bleeding, urine retention, wound face edema, postoperative infection) were observed.Results: 1. The recent Comprehensive efficacy analysis: clinical recovery after treatment treatment group, 15 cases, effective in 10 cases, effective in 5 cases, ineffective 0 cases, the total effective rate was 100%; control group, 10 cases of clinical recovery, 7 cases were markedly effective in 9 cases, 4 cases, the total effective rate was 86.67%. The level of information to compare two sample rank sum test, two groups of patients have more effect significant difference (P = 0.038 <0.05), the treatment group was significantly higher. 2. A comparative analysis of symptom scores before and after treatment: the treatment group pre-treatment symptom score, total score of 530, with an average points 17.67±3.83, control group, symptom score, total score of 493, with an average points 16.43±4.22, postoperative treatment group, symptom score, total score of 88, the average points 2.93±2.15, control group, symptom score, total score of 147, with an average points 4.90±4.22, preoperative and postoperative treatment group difference of 14.73±4.60, control group, preoperative and postoperative margin of 11.53±5.56 ; preoperative two points by an independent samples t test, P = 0.240> 0.05, no significant difference between the two groups, with comparable; treatment group patients before and after the integration by the paired t test, P = 0.000 <0.05, significantly difference between the control group preoperative and postoperative points by paired t test, P = 0.000 <0.05, significant difference; treatment group difference between preoperative and postoperative points and the control group difference between preoperative and postoperative points by an independent sample t test, P = 0.018 <0.05, significant difference. 3. Anal sphincter function of a comparative analysis of restraint: the normal anal function after treatment group, 30 patients were 0 cases better, worse, 0 cases, the total rate of 100% of the normal control group, 24 patients with normal anal function, is better 6 cases, worse, 0 cases, the total normal rate of 80.00%. The level of information to compare two sample rank sum test (P = 0.010 <0.05), with a significant difference in postoperative anal function of the treatment group were significantly higher than normal. 4. A comparative analysis of postoperative complications: Postoperative pain treatment group, 5 cases, bleeding in 2 cases, infection in 1 case; control group, 8 cases of pain, bleeding in 10 cases, infection in 8 cases. Theχ2 test, P values were 0.347,0.010,0.010, after the two groups in the incidence of postoperative pain were no significant differences in postoperative bleeding and postoperative wound infection rate was significant difference in the treatment group was significantly lower than the control group. 5. A comprehensive long-term efficacy of analysis: efficacy analysis between the two groups in Table 4. Patients after 90 days of follow-up, treatment group, 13 cases of clinical recovery, effective in 11 cases, effective in 5 cases, 1 patient, with a total effective rate was 96.67%; control group, 10 cases of clinical recovery, 7 cases were markedly effective in 9 cases, 4 cases, the total effective rate was 83.33%. The level of information to compare two sample rank sum test (P = 0.047 <0.05), two patients had significant efficacy difference between the treatment group was significantly higher long-term efficiency.Conclusion: Through the study found that a long line of strong points hanging treating constipation caused by puborectalis syndrome effect is significant, much better than full-beam part of the puborectalis resection. Qiang Du channel through the hole is located in sacral ridge side attending constipation, hematochezia, hemorrhoids, tail sacral pain; hang-line method is a traditional Chinese medicine, the use of a long line of strong points hang, hang up muscle bundle of the two / 3, both to ensure efficacy, but also does not affect the anal function, the appropriate support on a regular basis after the consolidation of long-term effects anal expansion can be effective in preventing recurrence. Method is simple and easy to clinicians, operation, safety is strong, fewer surgical complications, long-term efficacy and stability is the treatment of constipation caused by puborectalis syndrome, an ideal method of treatment.