成人直肠脱垂:如何选择手术方式?  

How to choose surgical approach for adult rectal prolapse?

作　　者：贾如江[1] 侯丽艳[1] 唐辉[1] 李明辉[1] 冯运章[1] 

机构地区：[1]邯郸市中心医院普外二科,河北邯郸056001

出　　处：《医学争鸣》2015年第2期45-49,共5页Negative

摘　　要：成人直肠脱垂严重影响患者生活质量,病因复杂,手术仍是目前治疗该病的主要手段。具体术式较多,主要的手术方式有经会阴手术、经腹手术和经腹腔镜手术,至今仍没有一个有效的数据评价各种术式的有效性和适应证,最理想的治疗方法仍然具有争议。如何进一步提高手术疗效,恢复良好的排便功能,降低复发率,减少并发症,是目前关注的问题。治疗方法的个体化可能会达到最佳的治疗效果。直肠脱垂手术方法的选择主要依赖于患者的临床特点和医生的经验。术前评估应该包括患者的解剖缺陷,脱垂的原因、程度,考虑合并症、症状和肛门直肠功能评价,以及患者的整体状态,以确定是否适合手术及确定手术的最佳途径和具体手术方式。虽然现有的研究数据有限,但术前至少应评估患者术后并发症,术后排便功能如便秘、排便失禁和术后复发等问题。对直肠脱垂患者实行围手术期系统的功能评价和规范的个体化手术治疗可能会使患者得到一个理想的治疗效果。Adult rectal prolapse seriously affects the quality of life of patients. Its cause is complex, and surgery is still the primary means of treating this disease. There have been many surgical approaches. The main operative procedures include transperineal surgery, transabdominal surgery and laparoscopic surgery. However, there has not been a valid data evaluation on the effectiveness of various surgical procedures and their indications. Which is the best treatment method is still controversial. The concerns are mainly focused on the issues of how to further improve the surgical outcomes, to better recovery patients＇ bowel function, to reduce the recurrent rate and complications. Individualized treatment approach may help to achieve the best therapeutic effect. Whether one should receive operation or the choice of surgical approaches for rectal prolapse depends on the patient＇s clinical characteristics and the surgeon＇s experience. Preoperative evaluation should include the anatomical defect, the reason for prolapse, prolapse severity, complications, symptoms and anorectal function evaluation, and overall condition of the patient, so as to determine whether or how to perform the surgery. Although existing research data are limited, preoperative prediction should be conducted at least in aspects of possible postoperative complications, postoperative bowel function such as constipation, fecal incontinence and recurrence. With perioperative functional evaluation system and standardized individualized surgical approach, the patient with rectal prolapse may get a desired therapeutic effect.

关 键 词：直肠脱垂 经会阴手术 经腹手术 腹腔镜手术 术式选择 个体化 

分 类 号：R657.19[医药卫生—外科学]