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目的:研究阴道内支架置入技术在治疗阴道后壁膨出伴直肠出口梗阻型排便困难中的临床价值。方法:对2010年10月至2015年6月我院收治的阴道后壁膨出伴直肠出口梗阻性排便困难的41例患者采用阴道内支架置入技术进行治疗。比较患者接受治疗前后的主观症状变化、评估出口梗阻便秘的Longo’s评分变化,以及治疗前后直肠压力测定指标的变化情况。结果:41例患者的平均年龄(68.51±8.63)岁,孕次(3.70±0.98)次,产次(2.43±1.07)次。阴道后壁的POP-Q评分:Ba为(0.43±1.33)分,Bp为(1.14±1.57)分。治疗前后主观症状比较,自觉排便不尽感人数由22例降至11例,手指辅助排便人数由16例降至8例,差异有统计学意义(P<0.05),排便时间过长、排便费力出血及排便姿势怪异症状治疗前后无明显差异。与治疗前比较,治疗后Longo’s评分总分降低,差异有统计学意义[(7.95±3.23)分vs(10.85±3.45)分,P<0.05];各分项评分中应力强度评分、应力时间评分、排便不尽感评分、灌肠辅助排便评分、手指辅助排便评分均显著下降(P均<0.05),其它各项指标未见明显差异。直肠静息压力由治疗前的(3.57±0.97)mm Hg升至(3.82±0.92)mm Hg,直肠力排压力由治疗前的(27.48±8.02)mm Hg升至(29.87±7.34)mm Hg,差异有统计学意义;治疗前后肛门静息压力及肛门力排压力未见明显变化。结论:阴道内支架置入技术治疗阴道后壁膨出伴出口梗阻型排便困难安全有效。
Objective: To study the clinical value of intravaginal stent implantation in the treatment of vaginal posterior wall bulging with difficulty in rectal outlet obstruction. Methods: From October 2010 to June 2015 in our hospital, 41 cases of obstruction of vaginal posterior wall and rectal outlet with pelvic obstruction were treated by intravaginal stent implantation. The changes of subjective symptoms before and after treatment were compared to evaluate Longo’s score of constipation of obstruction and the change of rectal pressure before and after treatment. Results: The average age of 41 patients was (68.51 ± 8.63) years, 3.70 ± 0.98 times of pregnancy and 2.43 ± 1.07 times of birth. The posterior vaginal wall POP-Q score: Ba (0.43 ± 1.33) points, Bp (1.14 ± 1.57) points. Before and after treatment, the subjective symptoms were significantly lower (P <0.05), the number of spontaneous bowel movements decreased from 22 to 11, and the number of finger assisted defecation decreased from 16 to 8 (P <0.05) Bleeding and bowel posture weird symptoms no significant difference before and after treatment. Compared with those before treatment, the Longo’s score decreased significantly after treatment ([7.95 ± 3.23] vs (10.85 ± 3.45), P <0.05]. The scores of stress intensity, stress time (P <0.05), but no significant difference was observed in other indexes. The rectal resting pressure increased from (3.57 ± 0.97) mm Hg before treatment to (3.82 ± 0.92) mm Hg, and the pressure of rectal pressure increased from (27.48 ± 8.02) mm Hg before treatment to (29.87 ± 7.34) mm Hg, The difference was statistically significant; anal resting pressure before and after treatment and anal discharge pressure no significant change. Conclusion: Intravaginal stent placement is safe and effective in treating vaginal posterior wall bulging with outlet obstruction type defecation.