经肛门手术治疗直肠全层脱垂  

Transanal approach for complete rectal prolapse

作　　者：刘先桂[1] 江从庆[1] 丁召[1] 钱群[1] 吴云华[1] 郑科炎[1] 张廷涛[1] 张秋雷[1] 秦前波[1] 

机构地区：[1]武汉大学中南医院结直肠肛门外科,430071

出　　处：《临床外科杂志》2014年第12期934-935,938,共3页Journal of Clinical Surgery

基　　金：湖北省卫生厅科研一般项目资助（项目编号：JXB819）;武汉市中青年医学骨干人才项目

摘　　要：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。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.

关 键 词：经肛门直肠乙状结肠部分切除术 经肛门吻合器直肠切除术 改良经肛门吻 合器直肠切除术 直肠全层脱垂 

分 类 号：R657.19[医药卫生—外科学]