直肠黏膜袖状切除术治疗成年人完全性直肠脱垂的临床分析  

Clinical analysis of Delorme procedure for full-thickness rectal prolapse

作　　者：王厚东[1] 杨关根[1] 张秀峰[1] 裘建明[1] 邵书先[1] 沈忠[1] Wang Houdong;Yang Guangeng;Zhang Xiufeng;Qiu Jianming;Shao Shuxian;Shen Zhong(Department of Coloproctology,Hangzhou Third Hospital,Hangzhou 310009,China)

机构地区：[1]杭州市第三人民医院肛肠科,杭州310009

出　　处：《中国医师进修杂志》2022年第2期119-122,共4页Chinese Journal of Postgraduates of Medicine

基　　金：浙江省科技厅公益项目(LGF20H030002);杭州市卫生健康委员会一般项目(2017A26);杭州市科技局引导项目(20171226Y17)。

摘　　要：目的评估直肠黏膜袖状切除术(Delorme术)治疗成年人完全性直肠脱垂的安全性及有效性。方法回顾性分析2014年6月至2018年5月在杭州市第三人民医院接受Delorme术治疗的17例成年人完全性直肠脱垂患者临床资料,评估患者特征、手术资料、术后并发症、复发、便秘和肛门失禁水平。结果17例患者中女11例,男6例,年龄(68±9)岁。17例患者均顺利完成手术,手术时间(88±16)min,术中估计失血量(23±9)ml,术后住院时间(8±1)d。有2例患者术后出现并发症,围手术期无死亡病例。随访(16±2)个月有1例复发。5例便秘患者术前与术后便秘评分分别为(23±2)分和(11±3)分,差异有统计学意义(t=9.51,P<0.01),6例肛门不全失禁患者术前与术后失禁评分分别为(14±2)分与(6±2)分,差异有统计学意义(t=9.09,P<0.01)。结论Delorme术治疗成年人完全性直肠脱垂疗效确切,术后并发症少,复发率低,安全可行,可作为经会阴入路治疗完全性直肠脱垂的主要手术方式之一,但其远期疗效和术后肛门功能尚有待进一步研究。Objective To evaluate the safety and efficacy of Delorme procedure for adults with full-thickness rectal prolapse.Methods Clinical data of 17 adult patients suffering from full-thickness rectal prolapse undergoing Delorme procedure from June 2014 to May 2018 in Hangzhou Third Hospital were retrospectively analyzed.Patient characteristics,operative data,postoperative complications,recurrence of rectal prolapse,continence state and constipation state were evaluated.Results Eleven patients were female,6 patients were male with a mean age of(68±9)years.Operations were successfully performed in these 17 cases.The operation time was(88±16)minutes.The estimated blood loss during operation was(23±9)ml.The postoperative time of hospital stay was(8±1)d.Two complications in two patients were observed.There was no treatment related death.One recurrent case was observed during(16±2)months follow-up.The preoperative and postoperative mean constipation score of five patients with fecal constipation were(23±2)and(11±3)respectively(t=9.51,P<0.01).The mean fecal incontinence score of six patients with fecal incontinence,before and after Delorme procedure,were(14±2)and(6±2)respectively(t=9.09,P<0.01).Conclusions The Delorme procedure for adults with full-thickness rectal prolapse is a safe and effective surgery with less complications and low recurrence rate.The Delorme procedure may be one of the preferred option of perineal approach for adults with full-thickness rectal prolapse,but the long-term outcome of Delormer procedure and its effect on postoperative anal function need to be further studied.

关 键 词：直肠脱垂 成年人 Delorme术 经会阴入路 

分 类 号：R657.19[医药卫生—外科学]