| Background and aims:Chronic constipation is a very common disease in the modern population.Its morbidity is increasing year by year.Difficulty in defecation and fewer times of defecation are the most common symptoms.Rectal protrusion is an important cause of chronic constipation in women.It means that the loose anterior rectal wall is pushed to the vaginal side by the force of defecation,forming a pathological cystic bag,which results in the abnormal excretion of feces outside the anus,and then causes constipation symptoms.Conservative treatment of rectocele includes conservative treatment and surgical treatment.Biofeedback therapy is the representative of conservative treatment.Bioelectric stimulation is used to regulate the abnormal contraction of sphincter to alleviate the dysfunction of defecation.The clinical efficacy of biofeedback therapy alone is often unsatisfactory and prone to recurrence.Therefore,surgery has become the ultimate treatment.Rectal protrusion surgery has many methods,but the traditional surgical methods have gradually been less used because of the large wound,slow healing and large recurrence rate.In recent years,with the wide use of staplers and the rapid development of minimally invasive surgery,transanal stapler rectectomy has been adopted by many surgeons at home and abroad because of its great advantages such as small tissue damage,less bleeding and rapid recovery.Previous international mainstream surgery.At present,most scholars have applied defecography in anatomy to verify that surgery can eliminate the pathological anatomy of rectocele,improve rectal compliance,strengthen the strength of anterior rectal wall,and improve the symptoms of constipation.However,in the course of clinical diagnosis and treatment,it is often found that some patients with rectocele still have no obvious relief of dysdefecation after operation,while rectal finger examination and defecography also show that the protrusion part has disappeared.Many surgeons have doubts about this.Why do the patients with protrusion have a huge difference in the curative effect after operation,and whether they can reflect the curative effect after operation by some quantitative way? According to this idea,we studied the direction of anorectal manometry,explored the changes of quantitative indicators of defecation function in patients with rectocele after operation,and explored the relationship between the changes of these indicators and the curative effect of patients with rectocele after operation.Anorectal pressure measurement is a simple and non-invasive method.Its detection principle converts anal and rectal motive and sensory signals into electrical signals.Finally,the data are processed by computer.At present,the technology has been developed very maturely,its diagnostic value is great,and it has been widely used in clinic.The objective data of anorectal pressure measurement were used as the basis to evaluate the clinical efficacy of STARR for rectocele patients,and to analyze the relationship between the related indicators and the improvement of defecation function of rectocele patients,so as to guide clinical diagnosis and treatment.Objects and methods:Fifty-two patients with rectocele who were admitted to Anorectal Surgery Department of Hangzhou Second People’s Hospital from December 2016 to July 2018 were selected randomly.They were all female patients with Roman III diagnostic criteria.Their ages ranged from 38 to 72(55 +17)years,and other types of constipation were excluded by relevant examinations.Anorectal pressure was measured once before operation,and related indexes were recorded.STARR was performed after the contraindications were excluded.Two months after operation,defecography was performed to check whether the rectocele disappeared or not,and anorectal pressure was measured again to compare the changes of anorectal pressure index before and after operation.Results:Anal finger examination and defecography were performed in 52 patients with rectocele after operation.The structure of rectocele was eliminated.Dynamics indices showed that the resting pressure of anal canal before operation in the effective group(90.4%)was 83.86(+12.92 mm Hg),56.39(+9.12 mm Hg)after operation,the maximum systolic pressure of anus and rectum before operation was 160.94(+21.78 mm Hg),and after operation was 112.58(+8.61 mm Hg);the resting pressure of anal canal before operation in the ineffective group(9.6%)was 85.37(+4.46 mm Hg),72.55(+5.48 mm Hg)after operation,the maximum systolic pressure of anus and rectum before operation was 165.52(+9.25142.57(+6.51 mm Hg).Nonparametric rank sum test showed that the changes of resting pressure of anal canal and maximum systolic pressure of anus and rectum before and after operation were P < 0.05,compared with those of ineffective patients,P < 0.05.Among the acceptability indexes,the preoperative rectal sensory capacity of the effective group was 43.12(+6.57 ml),the postoperatively was 22.49(+4.72 ml),the preoperative maximal rectal capacity was 265.82(+33.45 ml),and the postoperatively was 192.16(+32.73 ml);the preoperative rectal sensory capacity of the ineffective group was 46.62(+3.47 ml),31.82(+1.33 ml),the preoperative maximal rectal capacity was 271.19(+18.76ml),and the postoperatively was 225.41(+15.74 ml The changes of rectal sensory capacity and maximal rectal capacity before and after operation were P <0.05,and the effective group was P < 0.05 compared with the ineffective group.Conclusions:Anorectal motility and acceptance were abnormal in patients with rectocele,and exceeded normal level.Pathological anatomy disappeared after STARR,but constipation symptoms of some patients were not improved significantly.Anorectal pressure measurement related indicators of all patients with rectocele decreased after operation,but the change of effective patients was more obvious.Through this study,the relevant indicators of anorectal pressure measurement can be used as an objective basis to reflect the curative effect of patients with rectocele after operation. |
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