| Objective:To study the feasibility of individualized surgical treatment of rectocele and analyze its advantages Methods:A total of 177 female rectocele who were operated in Department of Colorectal & Anal Surgery of First hospital Bethune of Jilin University which dated from December 2013 to December 2015 were selected. On the basis of defecography, patients were divided into three groups: moderate-severe simple rectocele of 72 cases(Group A); combined anterior rectal prolapse of 55 cases(Group B); combined with internal rectal mucosal intussusception of 50 cases(Group C), who were respectively treated with modified STARR(single semi pouch), modified STARR(double parallel semi pouch), modified STARR(double parallel type full pouch). Records of three groups’ operating time, blood loss, length of hospitalization, cost of hospitalization, pain, anal tenesmus, anal continence, postoperative clinical symptoms improvement index(ODS) and nearly long term complications. To evaluate the feasibility of individualized surgical treatment and analyze its advantages, we compared with the standard STARR surgery group recorded in the literature. Results:177 patients in three groups were all successfully completed the operation, the operation time of group A was 10.5±2.1minutes, the operation time of group B was 11.2±2.5 minutes, the operation time of group C was 12.1±2.6minutes, the operation time of group STARR was 20-30 monutes. The operation time of the three groups was significantly lower than that of the STARR. Blood loss in group A was 9.6±5.1ml, in group B was 10.1±5.5m L, in group C was 11.2±5.8ml, which were all in 5-10 ml. That in group STARR was 5-20 ml, which had no significance. Length of hospitalization of three groups was respectively 5.2±1.5weeks, 5.4±1.6weeks, 5.4±1.7weeks. According to the literature and clinical experience that of STAAR was 7-8days. The hospitalization costs of three groups 9.8±0.1thousand yuan, 10.0±0.1thousand yuan and 11.0±0.1thousand yuan. That of STAAR was 12-13 thouasnd yuan which was above the other three groups. The long-term curative effect(3-6 months): with 50 cases cured, 14 cases taking effect, 8 cases effected, the total effective rate was 88.9% in group A; with 37 cases cured, 13 cases taking effect, 5 cases effected, the total effective rate was 90.8% in group B; with 34 cases cured, 11 cases taking effect, 5 cases effected, the total effective rate was 90.0% in group C. The long-term curative effect of STAAR was 80.2%[46]. Anastomotic bleeding, rectovaginal fistula, anal stenosis and other complications were not happened intraoperative and postoperative in three groups. Postoperative pain, bleeding, anal tenesmus, increased frequency of defecation, bowel dysfunction and other complications were significantly reduced. The long-term clinical symptoms were all improved after surgery. ODS scores of the three groups were significantly decreased than preopretive. The surgical effect were similar with standard STARR, but the incidence of postoperative complications were significantly lower in the three groups. Conclusion:1. Three groups of rectocele patients with the individualized surgical treatment, compared with STARR operation, has the advantages of simple operation, less trauma, less bleeding, rapid postoperative recovery, less complications, low cost and so on. 2. Three groups of long-term curative effect is better than the STARR group, safe and stable, is worthy of clinical application and application. |
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