李鑫磊　李帅军

[摘要] 目的 研究經肛吻合器直肠切除术（Stapled transanal rectal resection，STARR）联合消痔灵注射术治疗直肠黏膜内脱垂的临床治疗效果。 方法 回顾性分析2019年6月至2020年6月湖南中医药大学第二附属医院肛肠二科收治的直肠黏膜内脱垂患者86例，根据患者的手术方式分为两组，甲组38例行STARR，乙组48例行STARR联合消痔灵注射术。比较两组患者术后15、45、90 d的治疗总有效率及并发症总发生率。 结果 术后15 d甲组治疗总有效率为92.105%，低于乙组的97.917%，但差异无统计学意义（P>0.05）;术后45 d甲组治疗总有效率为81.579%，低于乙组的95.833%，差异有统计学意义（P<0.05）;术后90 d甲组治疗总有效率为65.789%，低于乙组的85.417%，差异有统计学意义（P<0.05）。甲组并发症总发生率为23.684%，高于乙组的16.667%，但差异无统计学意义（P>0.05）。 结论 采用STARR联合消痔灵注射术治疗直肠黏膜内脱垂，可有效提升患者的临床疗效。

[关键词] 直肠黏膜内脱垂;消痔灵注射术;经肛吻合器直肠切除术;肛垫下移

[中图分类号] R574.63          [文献标识码] B          [文章编号] 1673-9701（2021）06-0064-04

Efficacy of stapled transanal rectal resection combined with Xiaozhiling injection in the treatment of rectal mucosal prolapse

LI Xinlei1   LI Shuaijun2

1.Graduate School of Hunan University of Chinese Medicine， Changsha   410208， China; 2.The Second Department of Anorectal， the Second Affiliated Hospital of Hunan University of Chinese Medicine， Changsha   410005， China

[Abstract] Objective To study the clinical effect of stapled transanal rectal resection（STARR） combined with Xiaozhiling injection in the treatment of rectal mucosal prolapse. Methods A total of 86 patients with rectal mucosal prolapse admitted to the Second Department of Anorectal， the Second Affiliated Hospital of Hunan University of Chinese Medicine from June 2019 to June 2020 were retrospectively analyzed. The patients were divided into two groups according to their surgical methods. A total of 38 cases in group A underwent STARR. A total of 48 cases in group B underwent STARR combined with Xiaozhiling injection. The total effective rate of treatment and the total incidence of complications were compared on the 15th， 45th， and 90th day after the operation. Results After surgery， the total effective rate in group A （92.105%） was lower than that （97.917%） in group B at 15 days after the operation， and the difference was not significant（P>0.05）. The total effective rate in group A（81.579%） was statistically significantly lower than that （95.833%） in group B 45 days after the operation（P<0.05）. The total effective rate of group A （65.789%） was statistically significantly lower than that （85.417%） of group B 90 days after the operation（P<0.05）. The total incidence of postoperative complications in group A was 23.684%， higher than that （16.667%） in group B， there was no significant difference between the two groups（P>0.05）. Conclusion STARR combined with Xiaozhiling injection in the treatment of rectal intramucosal prolapse can effectively improve the clinical efficacy of patients.

[Key words] Rectal mucosal prolapse; Xiaozhiling injection; Stapled transanal rectal resection; Anal cushion descending

直肠黏膜内脱垂是常见的出口梗阻型便秘的原因之一，临床表现为排便费力、难以解出、排便时间延长、便后有意再解，常伴有肛门坠胀等症状[1]，其本质为一种直肠的退行性改变，由于肌层间与黏膜层的组织过于松弛，导致无法固定，使直肠黏膜逐渐松弛、下垂[2];解剖方面主要与肛提肌和盆底筋膜薄弱有关[3]。症状轻微者经食疗、药物或运动等治疗后可以好转，严重者可扰乱患者正常作息，使其生活质量明显下降，造成心理和生理负担[4]。手术可以从根本解决出口梗阻问题，从而解决便秘引发的恶性循环[5]。经肛吻合器直肠切除术（Stapled transanal rectal resection，STARR）可以有效解决出口黏膜堵塞问题，短期取得显著疗效，但由于长期便秘导致的排便习惯改变，易造成患者病情反复，使其长期疗效欠佳。本研……