经肛门手术治疗直肠全层脱垂

目的：探讨经肛门入路手术方式治疗直肠全层脱垂的疗效。方法直肠全层脱垂38例，28例行经肛门直肠乙状结肠部分切除术（Altemeier术）；8例行经肛门吻合器直肠切除术（STARR术）；2例行改良经肛门吻合器直肠切除术（TST STARR Plus术）。结果切除直肠全层标本长度：Altemeier术8～30 cm，STARR术及TST STARR Plus术4～6 cm。术中并发症：STARR术及TST STARR Plus术各发生吻合器切割后钉合不全1例，给予3-0可吸收线缝合。术后近期并发症：无一例发生吻合口瘘，无一例术后严重早期并发症，2例Altemeier、1例STARR患者术后1周内出现吻合口出血，保守治疗成功。术后平均住院时间为6 d（5～8 d）。中位随访时间38个月（1～47个月），每日排大便次数1～3次，1例患者行Altemeier术后12．5个月复发，1例Altemeier术后吻合口狭窄给予多次扩肛后完全缓解。随访期间所有患者术后性功能未受影响。结论 Altemeier术是治疗＞5 cm的直肠完全脱垂的可靠术式；STARR术和TST STARR Plus术可用于治疗长度＜5 cm的直肠完全脱垂，但STARR术特别是TST STARR Plus术的远期疗效尚需进一步研究证实。

Transanal approach for complete rectal prolapse

Objective To investigate the outcomes of transanal approach for complete rectal pro lapse.Methods A total of 38 patients received surgical treatment for complete rectal prolapse,including28 patients with trans anal rectosigmoidectomy（Altemeier procedure）,8 patients with stapled transanalrectal resection（STARR procedure）and 2 patients with TST STARR Plus.Results The length of resec ted specimens were 8 ~30 cm in the Altemeier procedure and 4 ~6 cm in the STARR or TST STARRPlus.All the specimens were full thickness rectum.Intraoperative complications included incomplete cut ting line after stapling,which occurred in one patient with STARR and one patient with TST STARR Plus.These patients were treated with 3 0 absorbable sutures.Short term postoperative complications such asanastomotic bleeding were observed within the first week,including two patients with Altemeier one patientwith STARR.There were no anastomotic leakage and severe early stage complications.The average postop erative hospitalization was 6 days（5 ~8 days）.After The median follow up time was 38 months（1 ~47months）and the frequency of defecation ranged from 1 to 3 times.Recurrence occurred in one patient withAltemeier after 12.5 months.Anastomotic stricture occurred in one patient and then got released after analdilatation.During the follow up,sexual function in all patients was normal.Conclusion The Altemeierprocedure is a reliable surgery in treating complete rectal prolapse larger than 5 cm;STARR and TSTSTARR Plus could be used in complete rectal prolapse less than 5 cm.But their long time curative effect,especially the TST STARR Plus,calls for further study.