盆底韧带引导的腹腔镜盆底修复治疗直肠内脱垂的疗效分析  

The effect of laparoscopic rectopexy with Douglas pouch repair combined with procedure for prolapse and hemorrhoids (PPH) based on pelvic anatomy for rectal internal mucosal prolapse

作　　者：魏东[1] 张剑锋[1] 曹永丽[1] 杨阳[1] 杨维维 石守森 Wei Dong;Zhang Jianfeng;Cao Yongli;Yang Yang;Yang Weiwei;Shi Shousen(Institute of Anal-colorectal Surgery,No. 989 Hospital of PLA,Luoyang 471031,China)

机构地区：[1]中国人民解放军联勤保障部队第九八九中心医院全军肛肠外科研究所,河南省洛阳471031

出　　处：《中华普通外科杂志》2019年第1期31-34,共4页Chinese Journal of General Surgery

基　　金：河南省医学科技攻关项目(2011030031).

摘　　要：目的评价以盆底韧带为引导的腹腔镜盆底修复直肠悬吊联合痔上黏膜环切除术治疗直肠内脱垂的长期临床疗效。方法回顾性分析2009年3月至2011年9月在洛阳解放军第九八九中心医院接受治疗的78例直肠内脱垂患者,分为A组:37例患者实施盆底韧带引导下的腹腔镜盆底修复直肠悬吊术;B组:41例患者实施盆底韧带引导下的腹腔镜盆底修复直肠悬吊联合痔上黏膜环切术。结果术后第5年,B组的便秘缓解程度和直肠内脱垂的改善程度均好于A组[(-0.4±0.9)cm比(-1.0±1.1)cm,t=2.370,P=0.020];B组术后5年直肠内脱垂的复发率低于A组(10%比30%,χ2=4.995,P=0.025);两组Ⅰ~Ⅲ级并发症发生率比较差异无统计学意义(11%比12%,χ2=0.037,P=0.848)。结论盆底韧带引导下的腹腔镜盆底修复直肠悬吊术联合痔上黏膜环切术的临床疗效要好于盆底韧带引导下的腹腔镜盆底修复直肠悬吊术。Objective To evaluate the effect of laparoscopic rectopexy with Douglas pouch repair combined with procedure for prolapse and hemorrhoids (PPH) based on pelvic anatomy for rectal internal mucosal prolapse. Methods From Mar 2009 to Sep 2011.37 patients (group A) received laparoscopic rectopexy with Douglas pouch repair based on pelvic anatomy,and group B (n=41) received laparoscopic rectopexy with Douglas pouch repair combined with PPH.Constipation level,degree of internal prolapse,relapse and postoperative complications were assessed in 5 years after operation. Results 5 years after operation,the relief of constipation and the improvement of internal prolapse in group B were better than in group A [(-0.4±0.9)cm vs.(-1.0±1.1)cm,t=2.370,P=0.020].The recurrence rate in group B was statistically lower than that in group A (10% vs.30%,χ2=4.995,P=0.025).Grade Ⅰ to Grade Ⅲ complications between the two groups was not statistically different (11% vs.12%,χ2=0.037,P=0.848). Conclusions The effect of laparoscopic rectopexy with Douglas pouch repair combined with PPH based on pelvic anatomy for rectal internal mucosal prolapse was superior to laparoscopic rectopexy with Douglas pouch repair.

关 键 词：直肠脱垂 韧带 修复外科手术 直肠悬吊 痔上黏膜环切术 

分 类 号：R657.1[医药卫生—外科学]