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1、STARR手术治疗排便障碍综合征(ODS)肛肠科:汤献忠功能性排便障碍综合征(ODS)慢性便秘是一种常见的严重影响人类生活质量的疾病,其中功能性疾病引起的慢性便秘约占57.1%。因此,提高对功能性便秘的认识和诊治水平有十分重要意义。与慢性便秘有关的功能性胃肠疾病包括功能性便秘、功能性排便障碍及便秘型肠易激综合征。根据病理生理特点,可将功能性便秘分为慢传输型便秘、出口梗阻型便秘、和混合型三种类型。罗马Ⅲ诊断体系中将出口梗阻型便秘(OOC)归入功能性肛门直肠疾病中,称为功能性排便障碍综合征(ODS)。ODS的诊断A.诊断前症状出
2、现至少6个月,且近3个月有症状发作;B.患者必需符合功能性便秘的诊断标准:a.应包括以下两个或以上症状。a)至少25%的排便有努挣;b)至少25%的排便为硬粪块;c)至少25%的排便有不完全排空感:d)至少25%的排便有肛门直肠阻塞感;e)至少25%的排便需手助排便;f).每周排便少于3次。b.不用泻药软粪便少见。c.不符合肠易激惹综合症(IBS)的诊断标准。C.有排便时盆底肌不协调收缩,肛门括约肌松弛不够或排便时推进力不足的证据。ODS患者的影像学改变demonstratethecharacteristicanatomi
3、calabnormalitiesdemonstratedondynamicdefecographyandMRIinpatientswithODS.(a)asthepatientbeginstostrainananteriorrectocelebeginstoappear(b)thevaginaassumesahorizontalposition,therectoceleenlarges,andasmallintussusceptionbecomesapparentshowtheintraoperativeappeara
4、ncesofarectoceleandanorectalprolapse.(c)theinternalrectalprolapseincreasesanddescendstowardtheanalcanal(d)theinternalrectalprolapseplugstheanalcanal,therectocelefailstoempty,andcompleteobstructiontodefecationresultsDynamicMRIimagesillustratingthecharacteristicanato
5、micalabnormalitiesassociatedwithODS.(a)formationofalargeanteriorrectocele,(b)thevaginaassumesahorizontalposition,andtherectumevaginatesasarectoceleandinvaginatesasaninternalrectalprolapse,(c)anenteroceledescendstofillalow-lyingPouchofDouglas,obstructingdefecatio
6、n.bbladder,rrectum,iinternalrectalprolapse(intussusception),X-raydefecographyshowinganisolatedpulsionrectocele(r)duringstraining;smallbowel(S),bladder(B),vagina(V)X-raydefecographyshowinganenterocelefilledwithsmallbowelloops(Sb)fillingtherectovaginalspacedurings
7、training;rectum(R)andrectocele(re),vagina(V),bladder(B)Intraoperativeappearanceofarectocele.TheexaminingfingerintherectumbulgesforwardintothelowervaginaIntraoperativedemonstrationofinternalrectalprolapse.ThecircularanaldilatorofthePPH01setisplacedintheanalcana
8、l.Adryswabonaspongeholderisinsertedandslowlywithdrawn,bringingwithittheprolapsingdistalrectumInternalrectalprolapseasobservedthroughaflexibles