腹腔镜经腹前大肠部分切除加直肠悬吊固定治疗成人直肠全脱垂  

Laparoscopic Anterior Partial Proctocolectomy with Rectopexy for Complete Rectal Prolapse in Adults

作　　者：韩爱民[1] 祝丽丽[1] 朱家明[1] 刘绪轩 徐清[1] 孙佩全 

机构地区：[1]江苏省淮安市淮阴医院肛肠科,淮安223300

出　　处：《中国现代手术学杂志》2017年第6期406-409,共4页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨腹腔镜经腹前大肠部分切除加直肠悬吊固定治疗成人直肠全脱垂的临床疗效。方法回顾性分析2012年2月~2016年4月我科采用腹腔镜经腹前大肠部分切除加直肠悬吊固定,选择性加行肛门外括约肌折叠治疗成人直肠全脱垂11例患者的临床资料。结果 11例患者均顺利完成手术,其中7例加行外括约肌折叠术。本组手术时间平均(135.4±45.1)min,术中失血量(60.2±9.5)ml。11例患者中10例治愈,1例好转。1例术后发生切口感染,无吻合口瘘、腹腔感染、肠梗阻等严重并发症;随访12~60个月无复发。7例肛门失禁患者术后6月Wexner评分较术前明显下降(P<0.01),3例排便困难症状明显改善。结论腹腔镜经腹前大肠部分切除加直肠悬吊固定,选择性加行肛门外括约肌折叠治疗成人直肠全脱垂安全可行,复发率低,临床疗效满意。Objective To explore the safety and clinical efficacy of laparoscopic anterior partial proctocolectomy with rectal suspension for treatment of adult complete rectal prolapse. Method The clinical data of 11 cases suffered complete rectal prolapsed admitted from February 2012 to April 2016 who received laparoscopic anterior partial proctocolectomy with rectal suspension and selective external anal sphincter plication were analyzed retrospectively. Results All 11 cases were accomplished the surgery of laparoscopic anterior partial proctocolectomy with rectal suspension successfully,including 7 cases adding selective external anal sphincter placation. The average operation time was（135. 4 ± 45. 1） min and hemorrhage volume was（60. 2 ± 9. 5）ml. Of 11 cases,there was 10 cases cured and 1 case improved. Incision infection occurred in 1 case. No anastomotic fistula,abdominal infection,intestinal obstruction and other serious complications was found.There was no recurrence during 12 to 60 months follow-up period. The Wexner score was improved from 12. 5 ±2. 4 before the surgery to 3. 5 ± 0. 4 after the surgery in 7 cases of anal incontinence,and the difference was statistically（P 0. 01）. The symptoms of difficult defecation were improved significantly in 3 cases with difficult defecation. Conclusion The laparoscopic anterior partial resection of large intestine with rectal suspension and selective external anal sphincter plication is safe and effective treatment with lower recurrence rate for complete rectal prolapsed in adults.

关 键 词：直肠脱垂 直肠悬吊术 经腹前结直肠切除术 外括约肌折叠术 腹腔镜检查 

分 类 号：R657.19[医药卫生—外科学]