Internal rectal prolapse during defecation is proximal rectal mucosa and submucosa folded into the distal intestine or anal anus, not beyond
Internal rectal prolapse during defecation is proximal rectal mucosa and submucosa folded into the distal intestine or anal anus, not beyond the outer edge, and persist in the feces, accompanied with defecation disorders, mostly women, is a common clinical type of outlet obstruction constipation, treatment method however, the effect is different, more complications. For these patients, treatment for 6 months, we take the non operative treatment, no obvious remission, surgical treatment, in order to seek a little pain, curative effect clear, we use the lateral rectal mucosa suture combined with Zhi injection de Ling, obtain satisfactory results.
1 data and method 1.1 clinical data of 2011 -2014 in our hospital 62 cases of patients with internal rectal prolapse, were consistent with the diagnostic criteria of internal rectal prolapse, there were 2 males and 60 females, aged 32-65 years old, average 48.5 years old, 1.5-12 year history of constipation, all patients dre palpable rectal mucosa accumulation satiety, without occupying, defecography shown nesting depth "16mm, IRIII.III. 62 patients were randomly divided into treatment group and control group with 31 cases in each group, the treatment group underwent lateral rectal mucosa suture combined with Zhi de Ling Injection, the control group were treated with PPH, the average age of the two groups of patients with constipation, history and defecography showed no significant difference (P> 0.05), see the following table:
1.2 methods of treatment (1) patients in the control group took chest knee position, routine disinfection shop towels, epidural anesthesia, dre rectal no lesions after anal slow to accommodate 4, for 5min, the re sterilization of anorectal, in the dentate line of about 87.5px, with 3-0 micro Joe in line 3 point and 9 point needle, double ring suture in the submucosa, two purse interval of about 0.5-25px, 3,9 will pull wire, a nail on the seat is arranged in the purse string suture, tighten the purse and tie line, with the line will be pulled out from the purse line at the end of stapling side hole, hemostatic clamp purse line the broken ends, to maintain a certain tension, confirm the resection of the mucosal into the stapler casing end, then firing the stapler, remain closed above 30s. The stapler to relax after the exit, check the integrity of the mucosal resection, whether there are anastomotic bleeding, such as bleeding, available suture line of 8 suture. After thorough hemostasis, the anal canal in the drainage tube, pressure bandage. (2) in the treatment group, half an hour before operation enema, clean intestines. Patients with knee chest position, routine disinfection for perianal drape, local anesthesia, anal sphincter relaxation, conventional anal four to maintain 5min, long anoscopy cold light source into the upper anal canal connected to the rectum, as the rectosigmoid junction, rectum cavity disinfection again, visible to the rectal mucosa first several semi circular folds to uplift, the anterior wall of the rectum mucosa uplift is, in the end the first half with a circular fold uplift intermediate tissue forceps picked up, holding clamp needle threading 10 silk suture needle stick straight round the base vertically through the rectum and then folds, long needle holder in the fold on the edge of the clamping straight round the needle along the rectum cavity out backward along the intestinal cavity pulled out, pull ends pull line 10, push the line to push the knot at the mucosal matter, repeated ligation. And then the two sides of the junction of the 12.5px out of the suture ligation, each half of the annular mucosa suture 3-4 needle. Turn back the anus mirror, in a fold suture method until the tooth line 100px, in lower rectal anterior wall for inverted triangle three point suture, to strengthen the weak at the anterior wall of the rectum. About 20 stitches. Suture after rectal cavity mucosa disinfection again, between the base and the suture suture money, in order to Zhi Ling injection injection uniform elimination of 1:1, about Zhi Xiao Ling 20ml injection, after injection, the anus mirror back massage rectal mucosa, in order to eliminate Zhi spirit uniform absorption. After the operation, check the intestinal bleeding, bleeding, anal canal with drainage tube, filling the bandage.
The patients of the two groups were given after semi liquid diet, intravenous antibiotics and hemostatic drugs 7d, second days after conventional dressing, using self-made Schizonepeta lotion Hip Bath wash the anus, anal Thai Senna bolt.
1.3 observation and evaluation indicators were observed and recorded the patient's operation (operation time, intraoperative blood loss, postoperative pain, hospitalization time). Patients were followed up for first weeks, 1 weeks, January and 3 months.
1.4 efficacy criteria: the cure of rectal mucosa returned to normal, defecate unobstructed, without obstruction feeling, no straining after palpation of rectal mucosa without accumulation, intestinal cavity open. Better: the stool is still unobstructed, then occasionally endless feeling, occasionally straining unwell after palpation of rectal mucosa sections. Invalid: no significant change before treatment.
Treatment of 1.5 patients after evaluation method from the first defecation (usually after 1D) evaluation records, the main record of defecation is smooth, it has no sense of obstruction, after no perianal tenesmus, anal rectum mucosa is refers to the accumulation of satiety, and then according to the clinical manifestations and examination results and evaluate the therapeutic effect. Record content. Record the defecation, the first day after first months, third months, sixth months, 1 years of the 1 follow-up, by telephone and outpatient review combined, including defecation, palpation, defecation time, complications.
2.1 the operation of the two groups of patients in the treatment group compared with intraoperative bleeding, postoperative pain, hospitalization time, postoperative complications were better than the control group, the difference was statistically significant
Short and long-term effects of the two groups were compared by 2.2 during hospitalization and after discharge telephone follow-up, patients in different time of defecation, Eldar patients after the first 1 weeks after operation, no statistically significant difference between 1 months and postoperative defecation (P> 0.05), the difference was statistically significant in patients with defecation in March the two groups after surgery
2.3 postoperative complications, 2 patients in the control group within 24 hours after hemorrhage, timely disposal of bleeding, 5 cases of patients with perianal after straining feeling obviously, after the March review of 3 cases of patients with rectal mucosa prolapse recurrence, difficult defecation no remission, 5 patients with anal stenosis, treatment group there were no obvious complications in patients with obvious pain, complications such as urinary retention,.
Internal rectal prolapse by elderly women's reproductive organs recession, too much, kidney failure photo, gas subsidence induced colon collapse, accumulation in the anus, difficult defecation, the gas loss plays an important role in the pathogenesis of deficiency of rectal mucosa prolapse, therefore "inside" "then fill the empty", "astringent solid off" rule.
Zhi spirit is the main component of alum, gallnut, strong convergence, hemostasis, coagulation protein, antibacterial effect, injected into the rectum submucosa can cause aseptic inflammation, cause local tissue fibrosis, the relaxation of the rectal mucosa
Fixed with the muscle layer, no longer move, to achieve the purpose of solid injection. Consumer Zhi spirit play a certain time, so in the rectal mucosa at the smooth mucosa suture transverse relaxation, play role to the building of the steel skeleton,
Xiao Ling to Zhi injection, the effect of concrete, two together, completely to fix the rectal mucosa to mucosa, slack down, more reliable. Xiao Ling Zhi injection is a key to strict aseptic operation, disinfection, open bet
In order to shoot, injection injection in the end, between the base of the injected ligature and adjacent mucosa ligation, each injection of about 0.5ml, with submucosal red streaks appear appropriate, you should not even injection, the injection is too shallow, too deep, not injected into the rectum muscle layer, can not be worn out the intestinal cavity generally co injection of about 20ml.
This method has the advantages of safety, simple operation, definite curative effect, less complications, low cost, relative to the primary hospital, patients with limited economic capacity, so as to reduce the cost of treatment of patients, and the therapeutic effect before and after surgery without fasting, second days of surgery for defecation, under local anesthesia can be completed, also you can avoid PPH postoperative anorectal stenosis, according to the experience of the surgeon, full of anesthetics, anal sphincter to relax completely, the correct choice of the transverse suture site, usually in the rectosigmoid junction first half ring folds, each 3-4 fold suture needle, avoid in the same plane circular suture. Suture to tooth line 3cm.