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陈旧性会阴Ⅳ度裂伤40例诊治探讨
李春颖;朱兰;刘珠凤;孙大为;冷金花;陈娟;孙智晶;
0
(中国医学科学院北京协和医学院北京协和医院)
摘要:
目的:探讨陈旧性会阴Ⅳ度裂伤患者的诊治情况。方法:回顾性分析40例陈旧性会阴Ⅳ度裂伤患者的临床表现、手术治疗及术后疗效。结果:(1)40例患者临床上均表现为不同程度的大便失禁,19例性生活受影响,29例出现不同程度的排气失禁。(2)所有入院后均行会阴裂伤修补术,其中行肛门外括约肌的重叠缝合术12例,行肛门外括约肌的端-端缝合术28例。患者的总体治愈率67.5%(27/40),总体缓解率77.5%(31/40);随诊术后5年内的治愈率88.9%(16/18),5年后的治愈率50.0%(11/22);行重叠缝合术患者的治愈率50.0%(6/12)与行端-端缝合术患者的治愈率75.0%(21/28)比较,差异无统计学意义(P<0.05)。(3)术后主要并发症为发热2例,肛管阴道瘘5例,会阴疼痛5例。(4)11例患者术前、术后填写了简短生命质量量表(SF-12)。躯体成分(PCS)评分手术前(34.58±5.29分)低于手术后(46.05±3.24分),差异有统计学意义(P<0.05);精神成分(MCS)手术前评分(32.70±5.15分)低于手术后(45.38±3.53分),差异有统计学意义(P<0.05)。结论:会阴Ⅳ度裂伤修补术可以改善患者的临床症状、提高生活质量。手术的近期疗效好,远期疗效欠满意。肛门外括约肌的重叠缝合术和端-端缝合术的疗效还需要进一步观察。
关键词:  会阴Ⅳ度裂伤  肛门括约肌  重叠缝合术  端-端缝合术
DOI:
基金项目:
Treatment of Fourth-Degree Laceration of Perineum:an Analysis of Forty Cases
LI Chunying;ZHU Lan;LIU Zhufeng
(Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences)
Abstract:
Objective:To discuss the diagnosis and treatment of the fourth-degree lacerations.Methods:The clinical manifestation,treatment and prognosis of 40 patients with fourth-degree lacerations were retrospectively analyzed.Results:(1)All of the patients had different degree of fecal incontinence.Nineteen patients reported compromised sexual activity and 29 patients were with varied flatal incontinence.(2)Twelve patients had the operations of the external anal sphincter over-lapping repairs.Twenty eight patients had the operations of end-to-end repairs.The total cure rate was 67.5%(27/40) and the remission rate was 77.5%(31/40).Follow up showed within 5 years after the operation the cure rate was 88.9%(16/18),and 5 years after the operation cure rate was50.0%(11/22),there was no statistical significance difference in the cure rate between the external anal sphincter over-lapping repairs 50.0%(6/12) and end-to-end repairs 75.0%(21/28)(P>0.05).(3)The complication was fever(2 cases) and anal fistula(5 cases) and perineal pain(5 cases).(4)Eleven patients complished the questionnaire of SF-12(Short life quality scale) before and after the operation.The mean score of PCS(physical composition score) before and after operation was 34.58±5.29 and 46.05±3.24,respectively,and the mean score of MCS(mentality composition score) before and after operation was 32.70±5.15 and 45.38±3.53,respectively,and the differeces were both statistically significant(P <0.05).Conclusions:Surgical treatment can improve the patient’s clinical symptoms and quality of life.The short term effect is good,but the long term effect is not very good.The efficacy of over-lapping repairs and end-to-end repairs need further study.
Key words:  Fourth-degreelaceration  Analsphincter  Over-lappingrepairs  End-to-endrepairs

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