便秘，直肠前壁空虚所致 Constipation due to empty anterior rectum wall转载2008-8-1

正常人每天一次大便，成型而不干结。如果几天大便一次，甚至不用措施不会自主排便，伴随大便干结和排便困难就称为便秘。便秘是一个多因素病理现象，它既可以造成肛瘘和肛裂的局部损伤，也可由于毒素过度吸收入血而引起全身损坏，增加体内毒素，导致机体新陈代谢紊乱、内分泌失调及微量元素不均衡，从而出现皮肤色素沉着、瘙痒、面色无华、毛发枯干，并产生黄褐斑、青春痘及痤疮等。便秘还会引起轻度毒血症症状，如食欲减退、精神萎靡、头晕乏力，久之又会导致贫血和营养不良。甚至缩短寿命。

Normal people once a day defecate, forming but not dry knot. If you defecate once a few days, even without measures will not self-defecate, accompanied by bowel movements and defecation difficulties are called constipation. Constipation is a multi-factor pathological phenomenon. It can cause local damage to anal fistula and anal fissure, or it can cause systemic damage due to excessive absorption of blood by toxins, increase of toxins in the body, leading to metabolic disorders, endocrine disorders, and imbalance of trace elements in the body. As a result, skin pigmentation, itching, facial color, dry hair, and yellow brown spots, acne and acne. Conconstipation can also cause mild toxaemia symptoms, such as loss of appetite, lethargy, dizziness, and fatigue, which can lead to anemia and malnutrition for a long time. Even shorten life span.

病因：产伤，是最多见的原因，分娩时胎头冲开盆底时，阴道后壁肌肉损伤，直肠前凸形成假性憩室，由于直肠周围空虚，少量的积便不能压迫到感觉神经末梢，故而不能形成排便反射。

Causes: Injury is the most common cause. When the fetal head bursts into the pelvic floor during childbirth, the back wall muscle of the vagina is damaged, and the rectum is convex to form a pseudo chamber. Due to the emptiness around the rectum, a small amount of product can not be pressed into the sensory nerve endings., Therefore, it can not form defecation reflex.

诊断：便秘，性生活不满意，女方无高潮，性冷淡，男方感觉阴道胯松，阴道镜见：会阴陈旧裂伤，三合诊感觉盆腔空旷。钡灌肠可见直肠扩张。 有些人并发张力性尿失禁，憋不住尿等，严重的与子宫脱垂并存。

Diagnosis: constipation, sexual life is not satisfied, the woman does not have orgasm, sexual coldness, the man feels vaginal crotch loose, vaginal mirror: perineum old laceration, triple diagnosis feels pelvic cavity open. Barium enema shows rectal dilation. Some people have concurrent tension incontinence, unable to hold urine, etc., seriously coexisting with uterine prolapse.

安太治疗：直肠前壁加固术Antai treatment: anterior rectum reinforcement

手术经过：Surgery:

患者取膀胱截石位，常规消毒外阴、阴道，铺无菌巾。麻醉成功后。用副肾生理盐水注入阴道直肠间隙。

The patient takes the bladder to intercept the stone, the routine disinfection vulva, the vagina, spreads the sterile towel. After successful anesthesia. Inject vaginal rectum space with secondary renal saline.

1、从用大窥器横行张开阴道，从后穹隆的宫颈部至处女膜缘梭形切开阴道粘膜，宽2-4cm，刮去切缘内阴道后壁黏膜。

1, from the use of a large voyeur to open the vagina, from the posterior dome of the palace neck to the hymen edge shuttle cut into the vaginal mucosa, width 2-4 cm, scratch the posterior vaginal wall of the cut edge.

2、用3-0可吸收线，将切口两内缘对合连续缝在一起(包饺子)。

2, with a 3-0 absorbable line, the two inner edges of the incision are sewn together(dumpling).

3、两侧切口暴露下面肌肉，4号双丝线纵向间断缝匝肌肉纤维，每侧3-5匝，然后将缝匝的线段对对打结，将肌肉拉紧缩短(捆韭菜)。

3, the two sides of the incision expose the muscles below, the 4th double wire longitudinal interspersed muscle fibers, 3-5 turns on each side, and then the stitches of the stitches are tied to each other, shortening the muscles(tied leeks).

4、潜行铺入网片一块。4, sneaking into the screen piece.

5、3-0可吸收线线将切口两外侧缘对合缝在一起(搭桥)。5, 3-0 absorbable line lines sew the two lateral edges of the incision together(bypass).

6、腹腔镜下暴露后穹窿，在直肠前面7号丝线连续缝合4cm，下面与阴道的缝合对接，上面不留死腔，(道格拉斯窝变浅)。

6, laparoscopic exposure of the stork, in the front of the rectum 7 wire continuous suture 4cm, the bottom and vagina suture and docking, there is no dead cavity,(Daogelasiwo shallower).

7、并发张力性尿失禁者，同时实施尿道中段悬吊术(TVT)予以纠正;子宫脱垂者可以同时行腹腔镜下韧带缩短和悬吊术。

术后肛诊体会直肠前壁紧张而坚挺。阴道内放纱模具一个压迫止血，24小时后取出。留置尿管，给予抗炎对症治疗5天。

7, concurrent tension-induced urinary incontinence, while implementing urethral middle suspension(TVT) to correct; Uterine prolapse can be performed simultaneously with laparoscopic ligament shortening and suspension.

Postoperative anal diagnosis showed that the anterior rectum wall was tense and firm. The inside of the vaginal gauze mold is pressed to stop the bleeding and taken out after 24 hours. Retain the ureter, give anti-inflammatory treatment for 5 days.