starr手术治疗排便梗阻综合征ods.pptxVIP

STARR手术治疗排便梗阻综合征ODS会计学功能性排便障碍综合征（ODS）第1页/共33页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。第2页/共33页罗马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）。第3页/共33页ODS的诊断A.诊断前症状出现至少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患者的影像学改变第4页/共33页demonstrate the characteristicanatomical abnormalities demonstrated ondynamic defecography and MRI in patients withODS.第5页/共33页(b) the vagina assumes a horizontal position, the rectocele enlarges, and a small intussusception becomes apparent（a）as the patient begins to strain an anterior rectocele begins to appearshow the intraoperativeappearances of a rectocele and anorectal prolapse.第6页/共33页( d ) the internal rectal prolapse plugs the anal canal, the rectocele fails to empty, and complete obstruction to defecation results( c ) the internal rectal prolapse increases and descends toward the anal canal第7页/共33页Dynamic MRI images illustrating the characteristic anatomical abnormalities associated with ODS. ( a ) formationof a large anterior rectocele, ( b ) the vagina assumes a horizontal position, and the rectum evaginates as a rectoceleand invaginates as an internal rectal prolapse, ( c ) an enterocele descends to fill a low-lying Pouch of Douglas,obstructing defecation. b bladder, r rectum, i internal rectal prolapse (intussusception),第8页/共33页X-ray defecography showing an isolated pulsionrectocele (r) during straining; small bowel (S), bladder (B), vagina (V)X-ray defecography showing an enterocele filledwith small bowel loops (Sb) filling the rectovaginalspace during straining; rectum (R) and rectocele (re),vagina (V), bladder (B)第9页/共33页第10页/共33页Intraoperative appearance of a rectocele. Theexamining finger in the rectum bulges forward i