经肛“瓦”形直肠脱垂吻合器切除术治疗直肠脱垂的疗效观察  

Preliminary therapeutic effect of tile shape perineal stapled prolapse resection in treatment of rectal prolapse

作　　者：孙华文[1] 王琦[1] 杨厚来 王秋爽[1] 孙科明 

机构地区：[1]武汉大学人民医院胃肠外科,武汉430060

出　　处：《中国普外基础与临床杂志》2017年第9期1095-1099,共5页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨应用经肛"瓦"形直肠脱垂吻合器切除术治疗直肠脱垂的疗效。方法回顾性分析2013年12月至2015年8月期间于武汉大学人民医院胃肠外科接受经肛"瓦"形直肠脱垂吻合器切除术治疗的31例直肠脱垂患者的临床资料。手术在静吸复合全身麻醉和(或)硬膜外麻醉下完成,使用直线切割吻合器同时切开2~4个点位的脱垂直肠肠壁,形成数个"瓦"形直肠瓣,再用弧形切割吻合器完成吻合。结果 31例直肠脱垂患者中男8例,女23例;年龄(65.8±3.2)岁。Ⅱ度直肠脱垂14例,Ⅲ度直肠脱垂17例,均无其他盆腔脏器脱垂。中位病程5.8年。术后31例患者随访0.5~7.0个月,其中24例痊愈,7例好转。Ⅱ度直肠脱垂切开4个点位和Ⅲ度直肠脱垂切开3个点位者所切除脱垂标本质量最重,明显重于其他点位数切开者(P<0.05),并且发现Ⅱ度直肠脱垂患者切开4个点位者没有出现复发,其他点位数切开者则出现2例轻度复发;Ⅲ度直肠脱垂患者切开3个点位者没有出现复发,其他点位数切开者则出现5例复发。结论本组有限病例的初步研究结果提示,经肛"瓦"形直肠脱垂吻合器切除术安全、有效,其最关键的步骤在于使用直线切割吻合器同时切开2~4个点位的脱垂直肠肠壁,形成数个"瓦"形直肠瓣,再用弧形切割吻合器完成吻合,其切开点位数目与手术疗效有关。Objective To evaluate therapeutic effect of tile shape perineal stapled prolapse resection in treatment of rectal prolapse. Methods The clinical data of 31 patients with rectal prolapse underwent tile shape perineal stapled prolapse resection in the Renmin Hospital of Wuhan University from December 2013 to August 2015 were retrospectively analyzed. All the patients with rectal prolapse were performed the tile shape perineal stapled prolapse resection with general anesthesia and （or） epidural anesthesia. The prolapse was completely pulled out and then axially cut open with a linear stapler in the lithotomy position. Finally, the prolapse was resected stepwise with the curved stapler at the prolapse＇s uptake. Results There were 8 males and 23 females in the 31 patients. The age was （65.8±3.2） years old. There were 14 patients with Ⅱ degree and 17 patients with Ⅲ degree prolapses. The median course was 5.8 years. The 31 patients were followed up for 0.5-7.0 months. Of 31 cases, the 24 cases were cured and 7 cases were better. It was found out that there was a significant difference between the number of axially cut open with a linear stapler and the weight of specimen （P〈0.05）. And there was a significant difference between the number of axially cut open with a linear stapler and the recurrence （P〈0.05） too. When the number of axially cut open with a linear stapler were 4 for Ⅱ degree and 3 for Ⅲ degree, the treatment had been proved to be the highest efficacy. Conclusions Preliminary results of limited cases in this study show that tile shape perineal stapled prolapse resection is safe and effective in treatment of rectal prolapsed. Key of operation is that prolapse is completely pulled out and then axially cut open with a linear stapler at some o＇clock for 2-4 points and rectal valves are formed. Prolapsed is resected stepwise with curved stapler at prolapse＇s uptake. When number of axially cut open with a linear stapler are 4 for Ⅱ degree and 3 for Ⅲ degree, it could achieve

关 键 词：直肠脱垂 经肛“瓦”形直肠脱垂吻合器切除术 治疗效果 

分 类 号：R657.19[医药卫生—外科学]