| Objective: Three kinds of operation methods will be used to study and evaluate the clinical effect of posterior vaginal wall incision suture in the treatment of severe RC. We will compare from the overall efficiency, postoperative complications, operation and hospitalization time, cost, symptom score,the short-term and long-term effect.Methods: The 90 patients eligible for severe rectocele, were randomly divided into A, B, C three group by the method of digits table, each group included 30 cases. After inspection, the three groups in age, the disease duration and the rectocele depth, had no significant difference, P>0.05. Patients in group A,as the observation group,received the treatment of transvaginal incision and repair operation. Patients in group B and group C is the control group.Group B received the treatment of minimally invasive closed repair operation(columnar suture),group C with stapling technique(STARR).The clinical efficacy of the three group was observed and analysed,mainly from the cure rate,postoperative complications(postoperative bleeding,postoperative pain, postoperative tenesmus swells,postoperative infection), the operation time, length of hospital stay,and cost of hospitalization,symptom score(before surgery, 6 weeks after surgery and 1 year after surgery),and the short-term(6 weeks after surgery) and long-term(1 year after surgery) effect.Result:1 The comparison of the three groups in the overall efficiency at 6 weeks after surgeryIn group A, the number of clinical recovery is 19 cases, markedly efficiency is 6 cases, efficiency is 3 cases, invalid is 2 case, the total effective rate of group A is 93.3%. In group B, the number of clinical recovery is 18 cases, markedly efficiency is 6 cases, efficiency is 3 cases, invalid is 3 case, the total effective rate of group B is 90.0%. In group C, the number of clinical recovery is 18 cases, markedly efficiency is 5 case, efficiency is 4 case, invalid is 3 case, the total effective rate of group C is 90.0%. P>0.05,The three groups had no significant difference.2 The comparison of the three groups in postoperative complicationsPostoperative bleeding: group A includes 0 cases, group B includes 0 case, group C includes 2 case. Postoperative pain: group A includes 2 cases, group B includes 3 cases, group C includes 4 cases. Postoperative tenesmus swells: group A includes 0 cases, group B includes 7 cases, group C includes 8 cases. Postoperative infection: 0 case. Group A was compared with group B and group C, P<0.05, they had significant difference. In postoperative tenesmus swells, group B and group C were compared with group A, P<0.05, they had significant difference. In other ways, P>0.05, the three groups had no significant difference.3 The comparison of the three groups in operation time,the length of hospital stay and the hospitalization costThe operation time in group A is 46.37±6.73 minutes, in group B is 18.21±4.51 minutes, in group C is 19.36±2.46 minutes. The length of hospital stay in group A is 14.37±3.14 days, in group B is 9.37±4.19 days, in group C is 10.62±3.72 days. The hospitalization cost in group A is 9641.79±430.38 yuan, in group B is 8309.3±503.72 yuan, in group C is 13542.91±692.82 yuan.. P<0.05,The three groups had significant difference.4 The comparison of the three groups in symptom scoreThe symptom score of the three groups: group A : before surgery, the symptom score is 13.21±2.07; 6 weeks after surgery, the symptom score is 4.32±1.53; 1 year after surgery, the symptom score is 4.30±1.57. Group B : before surgery, the symptom score is 13.52±1.98;6 weeks after surgery, the symptom score is 4.69±1.84; 1 year after surgery, the symptom score is 6.41±1.73. Group C: before surgery, the symptom score is 13.51±1.44; 6 weeks after surgery, the symptom score is 4.58±1.76; 1 year after surgery, the symptom score is 6.67±1.25.The comparison between three groups: the three groups were compared before surgery, P>0.05, they had no significant difference. They were compared at 6 weeks after surgery, P>0.05, they had no significant difference.Group A was compared with group B and group C at 1 year after surgery, P<0.05, they had significant difference.The comparison within each group: The symptom score of the three groups in 6 weeks after surgery and 1 year after surgery were compared with the score before surgery, P<0.05, they had significant difference. The symptom score of the group A in 6 weeks after surgery was compared with the score of 1 year after surgery,P>0.05, they had no significant difference.The symptom score of the group B and group C in 6 weeks after surgery was compared with the score of 1 year after surgery,P<0.05, they had significant difference.5 The comparison of the three groups in the short-term effect at 6 weeks after surgeryThe comparison of the three groups in symptom score at 6 weeks after surgery,P>0.05, they had no significant difference6 The comparison of the three groups in the long-term effect at 1 year after surgeryThe comparison of the group B and C with group A in symptom score at 1 year after surgery,P<0.05, they had significant difference.Conclusion: The surgical repair of Rectocele through posterior vaginal wall can effectively improve the patients’ symptoms in Rectocele.In the incidence of postoperative complications,the surgical repair of Rectocele through posterior vaginal wall was lower than the surgical repair of Rectocele through rectum.And this operation has the advantages of easy operation, safety, low cost,and reduces the patients pain and economic burden.What’s more,the short-term and long-term effect of the surgical repair of Rectocele through posterior vaginal are better.And the recurrence rate is lower.So it is worthy of further clinical application. |
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