Delorme手术治疗直肠全层脱垂患者14例疗效观察

2010年4月～2012年4月,我们采用直肠黏膜切除肌层折叠缝合术（ Delorme术）治疗直肠全层脱垂患者14例,取得较好疗效。现报告如下。 临床资料：本组直肠全层脱垂患者14例,男8例、女6例,年龄19～65岁,病程1～10年。临床表现为便后肛门全层脱垂,需要手法还纳。     

内镜下直肠黏膜多点烧灼术治疗直肠内脱垂疗效评价

目的与直肠黏膜纵行折叠加硬化剂注射术对比,评价内镜下直肠黏膜多点烧灼术治疗直肠内脱垂的疗效。方法前瞻性选取2013年8月至2018年10月东平县人民医院收治的直肠内脱垂患者80例。随机均分为对照组与治疗组2组,每组各40例。对照组患者采用直肠黏膜纵行折叠加硬化剂注射术治疗,治疗组患者采用内镜下直肠黏膜多点烧灼术治疗。对照组2例患者失访,最终38例患者纳入本研究。比较术前及术后3、6、12、18个月两组患者便秘症状评分。结果术前、术后3个月两组患者便秘症状评分差异均无统计学意义;治疗组患者术后6、12、18个月便秘症状评分均低于对照组患者[(2.0±0.2)分vs (2.2±0.3)分,(1.5±0.1)分vs (1.9±0.2)分,(0.7±0.1)分vs (1.7±0.1)分],且差异均有统计学意义(t=4.773、11.841、48.474,P均<0.001)。结论内镜下直肠黏膜多点烧灼术治疗直肠内脱垂操作简便,临床症状明显改善,长期疗效远优于直肠黏膜纵行折叠加硬化剂注射术。     

直肠黏膜排列固定注射术加肛门环缩术治疗直肠脱垂31例临床分析

直肠脱垂老年人发病率较高.我科自2003～2006年共收治（Ⅱ～Ⅲ度）老年RP病人31例,均采用直肠黏膜排列固定注射术加肛门环缩术治疗,疗效满意.     

涤纶带悬吊联合直肠前加固治疗完全性直肠脱垂89例报告

1990年1月-2005年12月我院采用涤纶带悬吊联合直肠前加固的方法治疗完全性直肠脱垂89例,疗效满意。现报告如下,     

吻合器痔上黏膜环切术和腹腔镜悬吊手术在重度直肠黏膜脱垂治疗中的疗效对比

重度直肠黏膜脱垂严重地影响患者的日常生活质量,因此,采取有效的手术治疗十分必要〔1,2〕。吻合器痔上黏膜环切术(PPH)和腹腔镜直肠悬吊手术是临床上常见的用于治疗重度直肠黏膜脱垂的手术方式〔3〕。本研究拟分析PPH和腹腔镜直肠悬吊手术各自疗效。     

经直肠修补联合PPH治疗直肠前突及黏膜脱垂32例疗效分析

2006年12月-2008年4月,我们对32例直肠前突〉3．5cm、直肠黏膜脱垂的患者,实施直肠前突修补联合直肠黏膜环切（PPH）治疗,术后效果良好。现报告如下。     

腹腔镜盆底修复直肠悬吊联合痔上粘膜环切术治疗直肠粘膜内脱垂的长期疗效评价

目的评价腹腔镜盆底修复直肠悬吊联合痔上粘膜环切术治疗直肠粘膜内脱垂的长期临床疗效。 方法2008年2月至2009年9月选择接受治疗的直肠粘膜内脱垂患者98例,根据采用手术方式的不同分为2组,A组(n＝52)实施痔上粘膜环切术,B组(n＝46)实施腹腔镜盆底修复直肠悬吊联合痔上粘膜环切术。在术前、术后的1年、3年、5年分别对2组患者便秘程度及术后临床疗效、复发例数、并发症情况进行评价。 结果术后5年B组便秘程度并未逐渐加重,2组总有效率比较差异有统计学意义(P<0.05),B组复发例数与A组比较差异均有统计学意义(P<0.05),2组I－III级并发症比较差异无统计学意义(P>0.05)。 结论腹腔镜盆底修复直肠悬吊联合痔上粘膜环切术治疗直肠粘膜内脱垂长期疗效确切,是一种安全的术式,具有创新性。     

直肠内脱垂382例的诊断和治疗

直肠内脱垂（ｉｎｔｅｒｎａｌｒｅｃｔａｌｐｒｏｌａｐｓｅ，ＩＲＰ）是指在排便过程中近侧直肠壁全层或粘膜层折入远侧肠腔或肛管内，不超出肛门外缘．是较常见的出口性盆底松弛性便秘类型之一．近年来随着排粪造影的推广应用，诊断和治疗水平均有较大提高，现就我院１...     

老年女性直肠前突合并直肠内脱垂118例的治疗体会

1996年2月～2006年10月我们对118例直肠前突合并直肠内脱垂的老年女性患者，采用经直肠行直肠前突修补术、直肠内脱垂注射术治疗，取得了满意的效果。     

Laparoscopic suture rectopexy without resection is effective treatment for full-thickness rectal prolapse

PURPOSE: The study was undertaken to evaluate the role of laparoscopic suture rectopexy without resection as a safe and effective treatment for full-thickness rectal prolapse. METHOD: Data were prospectively collected and analyzed on 25 patients who underwent laparoscopic rectopexy without resection for full-thickness rectal prolapse between October 1994 and July 1998. Four patients had conversions from laparoscopic to open surgery. Two patients had recurrent prolapse previously managed by Delorme's procedure. Another two patients had solitary rectal ulcer syndrome associated with their full-thickness rectal prolapse. There were a total of three males. Mean age was 72 (range, 37–89) years. The preoperative and postoperative course of each patient was followed up, with attention paid to first bowel movement, hospital stay, duration of surgery, fecal incontinence, constipation, recurrent prolapse, morbidity, and mortality. Follow-up was made by clinic appointments and, if necessary, by telephone review. RESULTS: Median follow-up period was 26 (range, 1–41) months. Mean duration of surgery was 96 (range, 50–150) minutes. Postoperatively, the median time for first bowel movement was four (range, 2–10) days. Median hospital stay was seven (range, 3–23) days. Overall, 15 patients (60 percent) either improved or remained unchanged with respect to continence. There was an improvement in 10 of 20 patients (50 percent) among those with continence Grade 2 or more (P<0.05). Seven patients (28 percent) remained incontinent. No patient became more incontinent after surgery. Constipation, which was present in 9 patients (36 percent) preoperatively, affected 11 patients (44 percent) after rectopexy (P>0.05; not significant). Postoperative morbidity included a port site hernia and deep venous thrombosis in one patient, a repaired rectal perforation, a retroperitoneal hematoma with prolonged ileus (1 case), and a superficial wound infection (1 case). One patient with solitary rectal ulcer syndrome in the laparoscopic surgery group remained unhealed despite resolution of the rectal prolapse after rectopexy and required abdominoperineal resection. Two patients (laparoscopic surgery = 1 and open surgery = 1) had severe constipation after surgery and both required loop colostomies. There were no cases of operative mortality or recurrent prolapse. CONCLUSION: Laparoscopic suture rectopexy without resection is both safe and effective in this frequently frail population and offers a minimally invasive approach that may have potential advantages for selected groups of patients with full-thickness rectal prolapse.Mr. Hartley was supported by an education grant from Autosuture UK.Presented in part to the Association of Surgeons of Great Britain and Ireland, Brighton, United Kingdom, May 4 to 7 1999.     

Constipation after rectopexy for rectal prolapse

The pathophysiology of constipation after rectopexy remains unclear: acquired anorectal dysfunction or preoperative colonic state are, by turns, the supposed culprit. The aim of this prospective study was to characterize the colorectal motility abnormalities encountered after such a surgical procedure. Twelve patients (10 females, 2 males, aged 50.5±5.2 years) complaining of severe constipation or its worsening after orr rectopexy (OR) for rectal prolapse were studied. Each underwent detailed interrogation as to their symptoms, left colonic manometry (basal and postprandial motor indexes and their caudad gradients in the sigmoid), anorectal manometry, evacuation proctography, and colonic transit time with radiopaque markers. Results were compared to those obtained in two control groups: 10 healthy volunteers (HV) and 12 patients complaining of a rectal prolapse (RP) observed consecutively during the same period of evaluation (June 90 to December 91). Before surgery, the OR and RP groups were similar with respect to mean age, sex ratio, weekly stool frequency, subjective dyschezia and manual anal supplies, constipation symptoms, and anal incontinence. OR patients differed significantly from the RP group in having a lower weekly stool frequency (2.5±2.2 vs 5.2±3.7,P<0.01) and a higher prevalence of abdominal pain (7 vs 1 patients,P<0.05). Above the rectopexy, global (135.9±38 vs 51±30.5 hr,P<0.01) and left (61.6±10 vs 18.2 hr,P<0.01) colonic transit times were significantly higher in OR patients; moreover, the basal motor index gradient was negative in all but one case (–94.1±101 vs 177.3±131,P<0.01). The OR patients differed from HV by their prolonged segmental transit time in the right colon (24.2±14 vs 9.9±8.2 hr,P<0.01) and the negative values of the postprandial colonic motor index (–191±281 mm Hg/min vs 39.8±72 mm Hg/min,P<0.05). No postprandial peristaltic rush was observed in the OR group. Below the rectopexy, the segmental transit time in the rectosigmoid, the qualitative and quantitative rectal emptying during evacuation proctography, and the anal and rectal manometric values were not, for the most part, different between the groups. In conclusion constipation following surgical procedure of rectal prolapse seems to be related in this study to acquired sigmoid motility disturbances above the rectopexy rather than to anorectal emptying.This work has been presented at the Digestive Disease Week (American Gastroenterological Association), San Francisco, California, May 13, 1992.     

选择性痔上黏膜环切术对直肠内套叠的临床疗效观察

目的分析选择性痔上黏膜环切术（TST）对直肠内套叠造成的出口梗阻性便秘的临床疗效。 方法收集聊城市人民医院肛肠外科于2013年1月至2015年1月期间收治的200例直肠内套叠的临床资料,根据术式分为选择性痔上黏膜环切术（TST）组（n=100）和痔上黏膜环切钉合术（PPH）组（n=100）,比较两组患者的临床疗效及住院时间,同时对术后疼痛、尿潴留、出血、肛门坠胀、吻合口狭窄等并发症的发生情况进行比较。 结果TST组与PPH组患者有效率分别为81%和79%,差异无统计学意义（χ²=0.13,P>0.05）;TST组患者住院时间明显少于PPH组（χ²=35.24,P<0.01）;除术后6小时以外,TST组术后疼痛（χ²_{24 h}=5.71,χ²_{48 h}=5.38,χ²_{72 h}=7.73;P<0.05）、尿潴留（χ²=9.28,P<0.05）、出血（χ²=7.04,P<0.01）、肛门坠胀（χ²=23.86,P<0.01）、吻合口狭窄（χ²=23.46,P<0.01）等并发症的发生率均明显低于PPH组,比较差异有统计学意义。 结论TST治疗直肠内套叠临床疗效显著,且住院时间短,术后并发症少。     

Results of treatment for rectal prolapse and fecal incontinence

Fifty-six patients were treated for rectal prolapse or incontinence. Rectal prolapse was present in 32 patients and was associated with fecal incontinence in 24 (75 per cent). Incontinence without prolapse was present in 24 patients, 12 of whom were less than 40 years old. Rectopexy was used for treatment of rectal prolapse. Surgical treatment of fecal incontinence was by post-anal repair; external sphincter reconstruction and surgery was advised only if control of diarrhea and electrical therapy had been of no benefit. Rectopexy was completely successful at controlling rectal prolapse in all cases, and only four of the 20 (20 per cent) patients with incontinence and prolapse remained incontinent after rectopexy alone. Incontinence was completely controlled by postanal repair in 58 per cent of patients and by external sphincter repair alone or in combination with postanal repair in 67 per cent. Using a combination of therapies 45 of 48 patients who were initially incontinent were improved (94 per cent), and 42 of the patients have complete control of defecation (87 per cent).     

Anterior rectopexy for full-thickness rectal prolapse: Technical and functional results

AIM:To assess effectiveness, complications, recurrence rate, and recent improvements of the anterior rectopexy procedure for treatment of total rectal prolapse.METHODS:MEDLINE, Pub Med, EMBASE, and other relevant database were searched to identify studies.Randomized controlled trials, non-randomized studies and original articles in English language, with more than 10 patients who underwent laparoscopic ventral rectopexy for full-thickness rectal prolapse, with a follow-up over 3 mo were considered for the review.RESULTS:Twelve non-randomized case series studies with 574 patients were included in the review.No surgical mortality was described.Conversion was needed in 17 cases(2.9%), most often due to difficult adhesiolysis.Twenty eight patients(4.8%) presented with major complications.Seven(1.2%) mesh-related complications were reported.Most frequent complications were urinary tract infection and urinary retention.Mean recurrence rate was 4.7% with a median follow-up of 23 mo.Improvement of constipation ranged from 3%-72% of the patients and worsening or new onset occurred in 0%-20%.Incontinence improved in 31%-84% patients who presented fecal incontinence at various stages.Evaluation of functional score was disparate between studies.CONCLUSION:Based on the low long-term recurrence rate and favorable outcome data in terms of low de novo constipation rate, improvement of anal incontinence, and low complications rate, laparoscopic anterior rectopexy seems to emerge as an efficient procedure for the treatment of patients with total rectal prolapse.     

Lomas-Cooperman technique for rectal prolapse in the elderly patient

Background A variety of surgical procedures is used to correct complete rectal prolapse (RP). We analysed the immediate and long-term results of the Lomas-Cooperman technique in the management of symptomatic RP in elderly patients with severe concomitant diseases. Methods Across a 13-year period, all patients with RP having undergone surgery with this procedure were retrospectively evaluated. The technique consisted in placing a triply folded piece of polypropylene mesh encircling the anal canal through a perineal approach. Results A total of 22 patients (20 female) with a mean age of 84 years (range, 72–93 years) with severe concomitant pathologies were assessed. Four patients were classified as ASA II and 18 as ASA III. Mean Karnofsky score was 50%, ranging between 40% and 60%. All patients were operated on under regional anaesthesia without incidents. Mean operative time was 35 min(range, 20–60 min) and mean hospital stay was 4.5 days (range, 2–17 days). The most common immediate postoperative complication was urinary tract infection, found in 18% of the cases. Mean follow-up was 32 months (range, 4–84 months). During follow-up, 4 cases (18%) of mesh exteriorisation were detected, requiring mesh trimming at the outpatient clinic. Rectal prolapse recurred in 2 patients; one of them was managed with a new cerclage reaching a satisfactory outcome. Thus, by intention-to-treat basis, the recurrence rate was 4.5%. Constipation was resolved in three out of 4 patients, but in 18% of the cases late faecal impact was recorded. Mean preoperative incontinence score improved from 5.1±0.62 to 3.4±1.61 (p<0.0001) after surgery. Conclusion Anal cerclage with the Lomas-Cooperman technique constitutes a simple and reproducible surgical technique with an acceptable morbidity and recurrence rate in high-risk elderly patients with RP.     

经腹与经会阴不同术式对直肠内脱垂手术的疗效分析

目的直肠内脱垂（IRP）是引起排便功能障碍的常见原因。当非手术治疗无效且症状逐渐加重,严重影响生活质量时,需要考虑外科手术治疗。但目前IRP手术方式繁多,疗效报道不一。本文将探讨经腹与经会阴不同手术方式对IRP手术的疗效。 方法采用回顾性队列研究方法。选取陆军军医大学大坪医院2000年1月至2018年12月期间诊断为IRP并符合ODS的便秘手术患者,收集并回顾性分析所有手术患者的临床资料及随访结果。所有患者被分为经腹手术组（n=69）和经会阴手术组（n=101）,其中经腹手术组又分为经腹直肠固定术组（n=28）和经腹直肠固定+乙状结肠切除术组（n=41）。评价指标：围手术期相关指标（包括手术操作时间、术中出血量、术后患者住院天数、患者住院费用以及术后并发症等）和功能性指标（便秘症状及生活质量改善情况）。分析比较不同手术方式的临床结局和疗效。 结果经腹手术组患者在手术时间、出血量、术后住院天数及住院费用方面要高于经会阴手术组（t=3.124,1.497,0.524,1.765;P＜0.001）。两组患者在术后早期并发症比较差异无统计学意义（χ²=0.141,P＞0.05）,而在术后晚期并发症比较,经腹手术组要高于经会阴手术组（χ²=6.844,P=0.009）。经会阴手术组术后复发率高于经腹手术组（χ²=4.777,P=0.029）。两组患者手术后Wexner便秘评分均显著降低（t=22.126,31.324;P＜0.001）。经腹直肠固定术组在手术时间、出血量、术后住院天数及住院费用方面要低于经腹直肠固定+乙状结肠切除术组（t=1.782,0.926,0.421,3.41;P＜0.05）。两组患者术后早期及晚期并发症、复发率比较均差异无统计学意义（χ²=0.129,0.333,0.885;P＞0.05）。两组患者手术后Wexner便秘评分、主观有效性及满意度评价比较均差异无统计学意义（t=-0.386,χ²=0.430;P＞0.05）。 结论经腹与经会阴手术治疗IRP患者均可以取得较好的术后疗效。经腹手术入路有更好的便秘缓解率及更低的复发率,而经会阴手术对特定人群仍然具有较低并发症率、更好的卫生经济学优势等优点。额外增加乙状结肠切除术并不能增加经腹手术的疗效。     

腹腔镜ISR治疗低位直肠癌的肿瘤学疗效及肛门功能观察

目的探讨腹腔镜内外括约肌间切除术（ISR）治疗低位直肠癌的肿瘤学疗效及对肛门功能的影响。 方法回顾性分析北京市丰台中西医结合医院78例低位直肠癌患者的临床资料,其中行腹腔镜ISR（观察组）42例,开腹ISR（对照组）36例。对比两组手术相关指标、肿瘤学疗效、肛门功能分级、术后并发症发生率及术后生存率。 结果两组手术时间比较差异无显著统计学意义（t=1.208,P>0.05）。观察组术中出血量显著低于对照组,通气时间、禁食时间、住院时间显著短于对照组（均P<0.05）。两组淋巴结检出数目、肿瘤大小、肿瘤下缘距远端切缘长度、组织分化程度、TNM分期比较差异无统计学意义（均P>0.05）。两组Wexner评分、排便频率、排便紧迫感、控粪能力降低、Kirwan肛门功能分级比较无统计学意义（均P>0.05）。观察组术后并发症发生率显著低于对照组（χ²=5.520,P<0.05）。两组术后3年生存率比较差异无统计学意义（χ²=1.065,P>0.05）。 结论腹腔镜ISR与开腹ISR治疗低位直肠癌在肿瘤学疗效、术后生存率及对肛门功能影响方面的效果相当,但前者手术创伤更小,可降低术中出血量,促进患者康复,减少并发症的发生,更具临床应用价值。     

Cauterization-plication operation in the treatment of complete rectal prolapse

The current communication presents a simple technique for treatment of complete rectal prolapse (CRP). The study included 28 patients presenting with CRP (mean age, 36.4 years; 4 children 2–12 years; 17 female and 11 males). Fourteen patients had fecal incontinence. With the patient under general anesthesia in lithotomy position, the prolapsed rectum was pulled outside the anal canal, the mucosa was cauterized in vertical lines and the exposed muscle layer was plicated by 2/0 coated Vicryl sutures. Posterior levatorplasty was done in 14 adult patients in whom the length of prolapsed segment was more than 10 cm and who were incontinent due to a wide levator hiatus. The postoperative follow up was 31.6±14.8 months (mean±SD). Five had postoperative mucosal prolapse and one had recurrence 3 months of operation. Mucosal plication was performed for the five patients and the operation was redone for the recurrent patient. Fecal impaction, stricutre and fistula formation were not encountered. The technique is simple, easy and with minimal complications. Received: 22 November 2001 / Accepted in revised form: 8 February 2002