经腹与经会阴不同术式对直肠内脱垂手术的疗效分析  

Outcomes of different transabdominal and transperineal surgical procedures for internal rectal prolapse

作　　者：王李 李凡 李春穴 张安平 刘宝华 童卫东 Wang Li;Li Fan;Li Chunxue;Zhang Anping;Liu Baohua;Tong Weidong(Department of Gastric&Colorectal Surgery,Daping Hospital,Army Medical University,Chongqing 400038,China)

机构地区：[1]陆军军医大学大坪医院(陆军特色医学中心)胃结直肠外科,重庆400038

出　　处：《中华结直肠疾病电子杂志》2022年第5期384-391,共8页Chinese Journal of Colorectal Diseases(Electronic Edition)

基　　金：国家自然科学基金面上项目(No.81770541);重庆市技术创新与应用发展项目(No.cstc2019jscxmsxmX0227)。

摘　　要：目的直肠内脱垂(IRP)是引起排便功能障碍的常见原因。当非手术治疗无效且症状逐渐加重,严重影响生活质量时,需要考虑外科手术治疗。但目前IRP手术方式繁多,疗效报道不一。本文将探讨经腹与经会阴不同手术方式对IRP手术的疗效。方法采用回顾性队列研究方法。选取陆军军医大学大坪医院2000年1月至2018年12月期间诊断为IRP并符合ODS的便秘手术患者,收集并回顾性分析所有手术患者的临床资料及随访结果。所有患者被分为经腹手术组(n=69)和经会阴手术组(n=101),其中经腹手术组又分为经腹直肠固定术组(n=28)和经腹直肠固定+乙状结肠切除术组(n=41)。评价指标:围手术期相关指标(包括手术操作时间、术中出血量、术后患者住院天数、患者住院费用以及术后并发症等)和功能性指标(便秘症状及生活质量改善情况)。分析比较不同手术方式的临床结局和疗效。结果经腹手术组患者在手术时间、出血量、术后住院天数及住院费用方面要高于经会阴手术组(t=3.124,1.497,0.524,1.765;P<0.001)。两组患者在术后早期并发症比较差异无统计学意义(χ^(2)=0.141,P>0.05),而在术后晚期并发症比较,经腹手术组要高于经会阴手术组(χ^(2)=6.844,P=0.009)。经会阴手术组术后复发率高于经腹手术组(χ^(2)=4.777,P=0.029)。两组患者手术后Wexner便秘评分均显著降低(t=22.126,31.324;P<0.001)。经腹直肠固定术组在手术时间、出血量、术后住院天数及住院费用方面要低于经腹直肠固定+乙状结肠切除术组(t=1.782,0.926,0.421,3.41;P<0.05)。两组患者术后早期及晚期并发症、复发率比较均差异无统计学意义(χ^(2)=0.129,0.333,0.885;P>0.05)。两组患者手术后Wexner便秘评分、主观有效性及满意度评价比较均差异无统计学意义(t=-0.386,χ^(2)=0.430;P>0.05)。结论经腹与经会阴手术治疗IRP患者均可以取得较好的术后疗效。经腹手术�Objective Internal rectal prolapse(IRP)is a common disease causing defecation disorder.Surgical treatment should be considered when non-surgical treatment is ineffective,the symptoms are gradually aggravated,and the quality of life is impaired.However,there are many operative methods and different postoperative outcomes for IRP.This paper will discuss the effect of different surgical procedures of transabdominal and transperineal for IRP.Methods A retrospective cohort study was used.Patients with constipation who were diagnosed with IRP and met ODS in Daping Hospital,Army Medical University from January 2000 to December 2018 were selected,and the clinical data and follow-up results of all patients were collected and analyzed retrospectively.All patients were divided into transabdominal procedure group(n=69)and transperineal procedure group(n=101).The transabdominal procedure group was divided into transabdominal rectopexy group(n=28)and transabdominal rectopexy+sigmoidectomy group(n=41).Evaluation indexes:perioperative related indexes(including operation time,intraoperative bleeding,postoperative hospitalization days,hospitalization expenses and postoperative complications)and functional indexes(improvement of constipation symptoms and quality of life).The clinical outcomes and effect of different surgical procedures were analyzed and compared.Results The operation time,blood loss,postoperative hospitalization days and hospitalization expenses in the transabdominal procedure group were higher than those in the transperineal procedure group(t=3.124,1.497,0.524,1.765;P<0.001).There was no significant difference in early postoperative complications between the two groups(χ^(2)=0.141,P>0.05),but the late postoperative complications in the transabdominal procedure group were higher than those in the transperineal procedure group(χ^(2)=0.844,P=0.009).The postoperative recurrence rate of transperineal operation group was higher than that of abdominal operation group(χ^(2)=4.777,P=0.029).The Wexner constipation scores

关 键 词：直肠 直肠内脱垂 经腹手术 经会阴手术 疗效 

分 类 号：R657.19[医药卫生—外科学]