| 李幸,翟春宝.直肠前突导致的排便障碍综合征的诊疗进展[J].安徽医药,2023,27(9):1726-1731. |
| 直肠前突导致的排便障碍综合征的诊疗进展 |
| Progress in diagnosis and treatment of dysdefecation syndrome caused by rectocele |
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| DOI：10.3969/j.issn.1009-6469.2023.09.007 |
| 中文关键词: 直肠前突 排便障碍综合征 出口梗阻型便秘 便秘 |
| 英文关键词: Rectocele Dysdefecation syndrome Outlet obstructive constipation Constipation |
| 基金项目:吴阶平医学基金会临床科研专项资助基金( 320.6750.2021-16-27) |
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| 中文摘要: |
| 直肠前突是临床上较难处理的疾病之一，易导致排便障碍综合征；且最佳诊治手段无统一结论。回顾近年来文献发现:在诊断及评估中，超声等检查与直肠前突的临床症状严重程度并无实质的联系，因此更须重视查体的作用；近年来发现呼吸中甲烷水平也可作为直肠前突的评估指标，希望进一步运用到临床工作中；直肠前突外科治疗，经肛门入路仍被认为是安全有效的手段之一，单环形吻合器及 Khubchandani联合吻合器直肠后壁切除等术式均被报道有效；经会阴入路，一些生物补片的使用并不会增加其并发症；对于高位直肠前突或伴有盆腔脏器脱垂的疾病，经腹直肠固定术能达到良好的解剖学效果，但对便秘改善的持续性一般；序贯缝合固定术、骶尾部固定联合直肠前突进行后路修复术丰富了术式；而生物补片、阴道支架等一些新材料、新技术的运用，为将来直肠前突的诊治提供了新的机遇和挑战。 |
| 英文摘要: |
| Rectocele is one of the diseases quite difficult to treat in clinical practice, which can easily lead to defecation disorder syn-drome. And there is no unified conclusion on the best diagnosis and treatment. Through reviewing the literature in recent years, wehave found that there is no substantial relationship between ultrasonography and the severity of clinical symptoms of rectocele in diag-nosis and evaluation, so we should pay more attention to the important role of preoperative examination. In recent years, it has beenfound that the level of methane in respiration can also be used as an evaluation index of rectocele, which is expected to be further ap-plied to clinical work. In the surgical treatment of rectocele, transanal approach is still considered to be one of the safe and effectivemethods; the resection of the posterior wall of rectum with single ring stapler and Khubchandani combined stapler have been reportedto be effective. When transperineal approach is applied, the use of some biological patches does not increase complications. As for highrectocele or that accompanied with pelvic organ prolapse, transabdominal rectal fixation can achieve good anatomical results, but thepersistence of constipation improvement is just so-so. Sequential suture and fixation, sacrococcygeal fixation and posterior repair of rec-tocele enrich the surgical methods. The application of some new materials and technologies such as biological patch and vaginal stentprovides new opportunities and challenges for the diagnosis and treatment of rectocele in the future. |
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