TST With PPH Joint Rectal Wall Repair Comparative Clinical Study On Treatment Of Rectocele

Also known as the posterior vaginal wall bulging rectocele, is a commondisease of old age, married by the middle class women in a medium is oneimportant reason for the cause of outlet obstruction constipation.Domesticpairs of the before the-rectum sudden the understanding of the disease thesurviving in less than.The rectocele best treatment is surgery, although manysurgical procedures, but all kinds of postoperative effects of poor overallsatisfaction, the recurrence rates still accounts for a very high ratio.Therefore,this combination of clinical practice, put forward the surgical indications forrectocele, and focus on observed the rectocele joint TST surgery postoperativeand long term efficacy and postoperative complications.Expect through thisclinical study to improve the rate of diagnosis of rectocele, the specificationrectum protrusion of the surgical indications, the treatment of rectal sudden abetter way to improve the surgery and reduce postoperative complications andreduce the relapse rate.1.The choice of a rectocele etiology and surgical indicationsRectocele pouch pocket, broke into the vagina caused by the rectal wall,recto-vaginal diaphragm and posterior vaginal wall is weak.Any can make thethree elasticity reduce the factors are able to to to lead to the the theoccurrence of prognathism in the rectum. O’clock the degradation of When thethe developmental defects or connective tissue of the of the organization,resulting in the rectum around the vagina support organizations supportfunction is at the same time in reduce the, this will form the rectocele of thehigh-risk factors.If you associated with poor bowel habits or long-termconstipation, so that the pressure inside the rectum, so the weak organization of separated over-expansion, the fascia tear, muscle transection, its flexibilityto further reduce the protrusion is more serious.In addition, dystocia,prolonged labor and vaginal delivery damage, can lead to an already weaktissue damage.In the feces after the pressure in the rectum, the rectal wall canbe herniated into the vagina, thus the formation of the rectum protrusion.Combination of the cause of the protrusion above the rectum, as asurgical standard by summing up the experience in our clinical work, in linewith the following:(1)constipation history of several years, at least2years.(2) clinicalsymptoms are serious, not only affect their daily lives, or even each time bymhs of treatment the symptoms improved markedly, and even aggravated.(3)the defecography suggest the rectocele II, III degree, that is≥16mm.(4) eansof laxatives or hand-assisted defecation.By the formal non-surgical therapy to3month the exclusion of other diseases may cause constipation.2.General information and randomizationObserved78cases of rectal protrusion patients were married women,aged38-65years (mean age47years).69cases of maternal, accounting for88.46%(69/78).All patients with history of constipation in2-25years. Whichmerged with II degree hemorrhoids with rectal mucosa prolapse31cases.78cases were divided into two groups, namely, treatment group,40controlgroup of38cases. After grouping the two groups in average age, history ofconstipation, defecography and Ⅱdegree hemorrhoids with prolapse of therectal mucosa Statistical analysis were not statistically different (p>0.05).Therefore, to meet the randomization requirements.3.Surgical methodsTreatment groups: patients take the left lateral position, after the entryinto force of the epidural anesthesia, routine disinfection of the perineum andrectum cavity, and Shop surgical towels single. Slow anal, refers to the capacity4. Surgery to his left index finger placed in the patient’s vagina tofind the weak parts of the rectovaginal septum and directs in the rectal wall,the line longitudinally folded suture rectal mucosa, submucosa and superficialmuscle of4-6needle. Rectovaginal septum is weak at the disappearance ofrectal wall tension in the capsular bag as standard. Thread7, respectively, inthe open window, the dentate line4.0cm from the rectal mucosa andsubmucosa OK mucosa suture leads traction. Two openings the anoscoperespectively two mucosa suture leads to traction or available single-wiresuture two; The anoscope three openings can be for the segmentation ofpurse-string suture leads to traction. TST stapler head is inserted into theinside of the anal, placed in the top of the purse-string suture line, tighten thepurse suture and ligation. The suture through the strip line leads from the sideholes of the stapler, the appropriate force sustained traction. Prolapse of therectal mucosa led into the stapler through the window of the anoscope nail slot,Clockwise to tighten the stapler, open the fuselage insurance, firing tocomplete the cutting and consistent. Stapler body wait30s, thecounter-clockwise rotation to open the anastomosis device and pull out. Thesurgical field without active bleeding, the oil yarn wrapped jelly drainage tube(cut3-4side holes) one, placed in the anus, surgery.Control group: Patients were left lateral position, epidural anesthesiaafter the commencement of regular disinfection of the perineum and rectumcavity, Shop surgical towels single. Slow anal to4refers to. Surgery to his leftindex finger placed in the patient’s vagina to find the weak parts of therectovaginal septum and directs in the rectal wall, the line longitudinallyfolded suture rectal mucosa, submucosa and superficial muscle of4-6needle.Gear online side about2.5cm and4.0cm at the3:00and9:00needle threadon the7th, for the purse-string suture of the mucosa and submucosa line.Rectal mucosa, intussusception patients with widened the spacing of the two purse-string suture, may be appropriate to increase the removal of the mucousmembrane of the formation of appropriate width (to match). PPH staplerhead-end extension to the top of the purse-string suture line to tighten thepurse line and ligation. With a thread through the side holes of the staplersuture leads to appropriate traction ligature. The intended removal of mucosaand submucosa into the casing side of the stapler, Clockwise to tighten thestapler, open the fuselage insurance, firing to complete the cutting andconsistent. Stapler body wait30s, the counter-clockwise rotation to open theanastomosis device and pull out. The surgical field without active bleeding,the oil yarn wrapped jelly drainage tube (cut3-4side holes) one, placed in theanus, surgery.4. Outcome measuresRecorded after1month,3months,6months,12months defecation,surgery near the long-term efficacy compared.Observed postoperativecomplications, the amount of analgesic drugs.5. Results(1).Treatment group and control group after four times of regularfollow-up, a significant improvement in symptoms compared withpreoperative.(2).Preoperative symptoms was no significant difference; after a threemonth efficacy, treatment and control groups were no significantdifferences.After6months and12months efficacy compared to treatmentgroup and control group, a marked difference in the treatment group than thecontrol group.(3).For the combined Ⅱdegree hemorrhoids with rectal mucosaoverlaying effect: patients were followed up for1,3,6,12months, nosignificant difference between treatment and control groups.(4).Postoperative complications compared: the treatment of postoperative complication rate was significantly lower than the control group.Within24hours after the treatment group,4patients using analgesics(tramadol injection100mg intramuscularly), accounting for10%(4/40);12cases using the same formulations of analgesics in the control group,accounting for31.58%(12/38). On both the degree of postoperative paintreatment group was significantly less than the control group.6.DiscussionAccording to the above discussion, the rectal wall repair joint TSTtreatment of rectal sudden we can draw the following conclusions:(1).The procedure can significantly improve patients ’defecation andimprove patients’ quality of life.(2).Term efficacy of the surgical treatment of severe rectal protrusionPPH rectal wall repair procedures for the treatment fairly long-term efficacyof the procedure was significantly better than the PPH joint rectal wall repair,but also further description of the TST with traditional surgeryeffectivenessand feasibility of combination treatment of rectal protrusion.(3).The technique of postoperative complications was significantly lessthan the control group, the more easily accepted by patients.ectal protrusion.(4).The technique is also applicable to patients with merged in thetreatment of degree II hemorrhoids or rectal mucosa, intussusception.