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排序方式: 共有63条查询结果,搜索用时 31 毫秒
1.
Laparoscopic rectopexy for complete rectal prolapse 总被引:5,自引:0,他引:5
A. C. Poen M. de Brauw R. J. F. Felt-Bersma D. de Jong M. A. Cuesta 《Surgical endoscopy》1996,10(9):904-908
Background: The purpose of this study was to evaluate the clinical outcome of laparoscopic rectopexy and its effect on anorectal function investigations.
Methods: Twelve patients with complete rectal prolapse without constipation underwent laparoscopic rectopexy. Pre- and postoperative evaluation included scoring of incontinence, anorectal manometry, and anal endosonography.
Results: No recurrences of rectal prolapse were seen (median follow-up 19 months). Continence improved in eight of nine preoperatively incontinent patients. Two patients had mild constipation after surgery. Median maximum basal pressure measured by anorectal manometry increased from 20 to 25 mmHg (p=0.005) and the rectoanal inhibitory reflex improved in seven patients (p=0.03). Rectal sensitivity did not change significantly. Endosonography showed asymmetry and thickening of the internal anal sphincter and submucosa preoperatively. After surgery the maximum internal anal sphincter thickness decreased from 3.0 mm to 2.6 mm (p=0.02).
Conclusions: Laparoscopic rectopexy improved continence in our patients. Anorectal function tests show a partial recovery of the internal anal sphincter. Laparoscopic rectopexy combines the low morbidity of minimal invasive surgery with the good outcome of abdominal rectopexy.Presented at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), Orlando, Florida, USA, 11–14 March 1995 相似文献
2.
Raftopoulos Y Senagore AJ Di Giuro G Bergamaschi R;Rectal Prolapse Recurrence Study Group 《Diseases of the colon and rectum》2005,48(6):1200-1206
PURPOSE This study was designed to determine what impact surgical technique, means of access, and method of rectopexy have on recurrence rates following abdominal surgery for full-thickness rectal prolapse.METHODS Consecutive individual patient data on age, gender, surgical technique (mobilization-only, mobilization-resection-pexy, or mobilization-pexy), means of access (open or laparoscopic), rectopexy method (suture or mesh), follow-up length, and recurrences were collected from 15 centers performing abdominal surgery for full-thickness rectal prolapse between 1979 and 2001. Recurrence was defined as the presence of full-thickness rectal prolapse after abdominal surgery. Chi-squared test and Cox proportional hazards regression analysis were used to assess statistical heterogeneity. Recurrence-free curves were generated and compared using the Kaplan–Meier method and log-rank test, respectively.RESULTS Abdominal surgery consisted of mobilization-only (n = 46), mobilization-resection-pexy (n = 130), or mobilization-pexy (n = 467). There were 643 patients. After excluding center 8, there was homogeneity on recurrence rates among the centers with recurrences (n = 8) for age (hazards ratio, 0.6; 95 percent confidence interval, 0.2–1.7; P = 0.405), gender (hazards ratio, 0.6; 95 percent confidence interval, 0.1–2.3; P = 0.519), and center (hazards ratio, 0.3; 95 percent confidence interval, 0.1–1.5; P = 0.142). However, there was heterogeneity between centers with (n = 8) and without recurrences (n = 6) for gender (P = 0.0003), surgical technique (P < 0.0001), means of access (P = 0.01), and rectopexy method (P < 0.0001). The median length of follow-up of individual centers varied from 4 to 127 months (P < 0.0001). There were 38 recurrences at a median follow-up of 43 (range, 1–235) months. The pooled one-, five-, and ten-year recurrence rates were 1.06, 6.61, and 28.9 percent, respectively. Age, gender, surgical technique, means of access, and rectopexy method had no impact on recurrence rates.CONCLUSIONS Although this study is likely underpowered, the impact of mobilization-only on recurrence rates was similar to that of other surgical techniques.Presented at the meeting of The American Society of Colon and Rectal Surgeons, Dallas, Texas, May 8 to 13, 2004 相似文献
3.
目的探讨腹腔镜下直肠乙状结肠部分切除联合直肠悬吊固定术治疗成人完全性直肠脱垂的疗效。方法对2010年5月至2013年5月期间笔者所在医院科室收治的32例成人完全性直肠脱垂患者行腹腔镜下直肠乙状结肠部分切除联合直肠悬吊固定术,总结手术疗效。结果32例患者的手术过程均顺利,无一例中转开腹手术。平均手术时间为114.7min(95~167min),平均术中出血量为80mL(55~150mL),术后平均住院时间为9.8d(6~14d),均全部治愈出院。术后32例患者获访3个月~4年(平均25.6个月),均无脱垂症状,肛门功能恢复良好,无术后并发症及复发。结论腹腔镜下直肠乙状结肠部分切除联合直肠悬吊固定术治疗成人完全性直肠脱垂的疗效良好,具有创伤小、恢复快、复发率低等优点,是一种具有较高临床应用价值的术式。 相似文献
4.
Werner A. Draaisma Dorothée H. Nieuwenhuis Lucas W. M. Janssen Ivo A. M. J. Broeders 《Journal of robotic surgery》2008,1(4):273-277
Robotic systems may be particularly supportive for procedures requiring careful pelvic dissection and suturing in the Douglas
pouch, as in surgery for rectal prolapse. Studies reporting robot-assisted laparoscopic rectovaginopexy for rectal prolapse,
however, are scarce. This prospective cohort study evaluated the outcome of this technique up to one year after surgery. From
January 2005 to June 2006, 15 consecutive patients with a rectal prolapse, either with or without a concomitant rectocele
or enterocele, underwent robot-assisted laparoscopic rectovaginopexy with support of the da Vinci robotic system. A prospective
cohort study was performed on operating times, blood loss, intra-operative and post-operative complications, and outcome at
a minimum of one year after surgery. Median age at time of operation was 62 years (33–72) and median body mass index 24.9
(20.9–33.9). Median robot set-up time was 10 min (3–15) and median skin-to-skin operating time was 160 min (120–180). No conversions
to open surgery were necessary. No in-hospital complications occurred and there was no mortality. Median hospital stay was
four days (2–9). During one year follow-up, two patients needed surgical reintervention. One patient was operated for recurrent
enterocele and rectocele one week after surgery. In another patient an incisional hernia at the camera port occurred three
months after surgery. At one year after surgery, 87% of patients claimed to be satisfied with their postoperative result.
Robot-assisted laparoscopic rectovaginopexy proved to be an effective technique with favourable outcomes in most patients
in this prospective series. The operating team experienced the support of the robotic system as beneficial, especially during
the dissection of the rectovaginal plane and suturing in the Douglas pouch. 相似文献
5.
腹腔镜辅助下盆底腹膜带直肠悬吊术治疗儿童完全性直肠脱垂 总被引:2,自引:0,他引:2
目的探讨腹腔镜腹膜带直肠悬吊术治疗儿童完全性直肠脱垂的可行性及临床效果。方法2004年8月~2008年10月,对6例完全性直肠脱垂(年龄2~6岁,平均3.5岁),在腹腔镜下利用直肠周围盆腔增厚松弛的腹膜,切取成两条"L"形带蒂腹膜条,折叠缝合固定于游离的直肠两侧壁,然后缝合在骶骨岬前的筋膜上悬吊直肠,最后将盆腔腹膜切缘缝合于直肠前壁包埋腹膜带并紧缩盆底。结果6例手术均获成功。手术时间95~210min,(120±24)min。术中出血〈10ml。术后随访6~54个月,平均28个月,均无脱垂复发,排便功能正常。结论腹腔镜下腹膜带直肠悬吊术治疗儿童完全性直肠脱垂效果良好,具有创伤小、恢复快、复发率低等优点,是一种具有较高临床应用价值的新术式。 相似文献
6.
Stephen Stonelake Oliver Gee David McArthur Ingo Jester 《Journal of pediatric surgery》2018,53(10):2077-2080
Background/purpose
To review our early experience of laparoscopic ProTack? rectopexy (LPR) in the management of full thickness rectal prolapse (FTRP) in children.Methods
Prospective case series of patients undergoing LPR between 2013 and 2017. Full laparoscopic mobilization of the rectum was performed from the sacral promontory to the pelvic floor. 'Wings' of the lateral mesorectal peritoneum left attached to the rectum are then fixed to the sacral promontory using ProTack?. Demographics, associated conditions, previous procedures for FTRP, follow up time, length of stay (LOS), short and long term complications and clinical improvement were assessed.Results
Seven consecutive patients with FTRP underwent LPR. The mean age was 9 years old (2–17) with a male to female ratio of 6:1. Median LOS was 1 day (1–2 days). Median follow up time was 17 months (10–38 months). All patients had complete resolution of symptoms within the follow up period.Conclusions
LPR is a simple, safe and effective procedure showing promising results in children. It negates the risks associated with the use of mesh and has the potential to avoid the higher risk of failure associated with suture rectopexy. It is important to ensure patients receive adequate analgesia and management of postoperative constipation. 相似文献7.
van den Esschert JW van Geloven AA Vermulst N Groenedijk AG Groenedijk A de Wit LT Gerhards MF 《Surgical endoscopy》2008,22(12):2728-2732
Introduction Obstructed defecation remains a serious syndrome. Several procedures have been applied to treat it. A concomitant enterocele
excludes some of these procedures, because of potential threat of damaging the bowel. The aim of this study was to assess
the outcome of patients who underwent laparoscopic nerve sparing ventral rectopexy for obstructed defecation syndrome with
concomitant enterocele.
Methods Seventeen patients were included. Data about clinical history, physical examination and a defecogram were collected. All patients
underwent a laparoscopic ventral rectopexy. Complications, hospital stay, postoperative morbidity and long-term outcome were
documented.
Results All patients underwent laparoscopic ventral rectopexy. The median operating time was 199 min (range 186–239 min). One conversion
laparotomy was required. Six patients had postoperative complications (ileus n = 2, posttraumatic leg dystrophy n = 1, wound infection n = 1, incisional hernia n = 2). The median hospital stay was 6 days (range 3–24 days). Fifteen patients had improvement of their defecation problem,
although six patients still had minor constipation symptoms. In one patient the mesh was rejected and finally removed.
Conclusion Obstructed defecation syndrome is a combined functional and mechanical problem. In selected patients, especially when an enterocele
is present, laparoscopic ventral rectopexy is a feasible technique, with an acceptable number of complications.
An erratum to this article can be found at 相似文献
8.
9.
Kariv Y Delaney CP Casillas S Hammel J Nocero J Bast J Brady K Fazio VW Senagore AJ 《Surgical endoscopy》2006,20(1):35-42
Background Laparoscopic repair (LR) of rectal prolapse is potentially associated with earlier recovery and lower perioperative morbidity,
as compared with open transabdominal repair (OR). Data on the long-term recurrence rate and functional outcome are limited.
Methods Perioperative data on rectal prolapse in relation to all LRs performed between December 1991 and April 2004 were prospectively
collected. The LR patients were matched by age, gender, and procedure type with OR patients who underwent surgery during the
same period. Patients with previous complex abdominal surgery or a body mass index exceeding 40 were excluded from the study.
Data on recurrence rate, bowel habits, continence, and satisfaction scores were collected using a telephone survey.
Results A total of 111 patients (age, 56.8 ± 18.1 years; female, 87%) underwent attempted LR. An operative complication deferred repair
in two cases. Among the 111 patients, 42 had posterior mesh fixation, and 67 had sutured rectopexy (32 patients with sigmoid
colectomy for constipation). Eight patients (7.2%) had conversion to laparotomy. Matching was established for 86 patients.
The LR patients had a shorter hospital stay (mean, 3.9 vs 6.0 days; p < 0.0001). The 30-day reoperation and readmission rates were similar for the two groups. The rates for recurrence requiring
surgery were 9.3% for LR and 4.7% for OR (p = 0.39) during a mean follow-up period of 59 months. An additional seven patients in each group reported possible recurrence
by telephone. Postoperatively, 35% of the LR patients and 53% of the OR patients experienced constipation (p = 0.09). Constipation was improved in 74% of the LR patients and 54% of the OR patients, and worsened, respectively, in 3%
and 17% (p = 0.037). The postoperative incontinence rates were 30% for LR and 33% for OR (p = 0.83). Continence was improved in 48% of the LR patients and 35% of the OR patients, and worsened, respectively, in 9%
and 18% (p = 0.22). The mean satisfaction rates for surgery (on a scale of 0 to10) were 7.3 for the LR patients and 8.1 for the OR patients
(p = 0.17).
Conclusions The hospital stay is shorter for LR than for OR. Both functional results and recurrent full-thickness rectal prolapse were
similar for LR and OR during a mean follow-up period of 5 years. 相似文献
10.
Abdominal rectopexy has been advocated as the treatment of choice for complete rectal prolapse. Recurrence rates are low raging
from 0–12% and fecal continence has been documented to improve in 3–75% of patients. As most patients are elderly and not
always fit enough to undergo abdominal procedure, various perineal approaches have been advocated. Depending on the type and
extent of the operation, these procedures have a recurrence of up to 38%. Laparoscopic rectopexy represents the latest development
in the evolution of surgical treatment of rectal prolapse. This technique aims to combine the good functional outcome of the
open abdominal procedure with the low postoperative morbidity of minimal invasive surgery. We present a laparosocpic rectopexy
on 72-year-old lady with a 10-year history of fecal incontinence and mucosal rectal prolapse.
Electronic supplementary material is available for this article at
Presented at the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) Annual Meeting, Dallas, April 28, 2006 相似文献