腹腔镜盆底三水平整体修复治疗男性直肠内脱垂的临床疗效分析  

Laparoscopic pelvic floor three-level internal repair in the treatment of male internal rectal prolapse

作　　者：王思远 曹永丽 张远耀 杨阳 杨维维 李宜璐 魏东 Wang Siyuan;Cao Yongli;Zhang Yuanyao;Yang Yang;Yang Weiwei;Li Yilu;Wei Dong(Institute of Anal-Colorectal Surgery,the 989th Hospital of the Joint Logistics Support Force of PLA,Luoyang 471031,China;Bureau of Postgraduate Affairs,Xinxiang Medical University,Xinxiang 453003,China)

机构地区：[1]解放军联勤保障部队第九八九医院全军肛肠外科研究所,洛阳471031 [2]新乡医学院研究生处,新乡453003

出　　处：《中华普通外科杂志》2023年第9期685-689,共5页Chinese Journal of General Surgery

基　　金：河南省医学科技攻关计划项目(2011030031)。

摘　　要：目的:对比腹腔镜盆底三水平修复术和经肛吻合器直肠切除术在治疗男性直肠内脱垂患者的临床效果。方法:本研究回顾性分析2013年2月至2017年10月期间中国人民解放军联勤保障部队第九八九医院收治的101例男性直肠内脱垂患者的临床资料,其中52例患者接受腹腔镜盆底三水平整体修复术(A组),49例患者接受经肛吻合器直肠切除术(B组),分别对术前及术后3个月、1年、3年的Wexner肛门失禁评分(WIS)、Wexner便秘评分(WCS)、胃肠生活质量指数(GIQLI)、直肠内脱垂程度(DIRP)进行系统评价。结果:术前两组年龄、BMI、排便次数(BM)、WIS、WCS、GIQLI、DIRP差异均无统计学意义(均P>0.05)。两组术后3个月、1年和3年WIS、WCS、GIQLI、DIRP与术前比较差异均有统计学意义(t=20.169、25.229、27.278、23.818、23.489、21.152、-3.550、-23.042、-22.901、82.852、40.915、30.010、11.323、13.237、11.452、19.473、18.647、17.108、-8.791、-5.254、-5.846、37.439、30.598、22.852,均P<0.001)。两组术后3个月GIQLI差异无统计学意义(t=1.428,P=0.156),A组WIS、WCS、GIQLI、DIRP在术后3个月、术后1年和术后3年的结果均明显优于B组,差异均有统计学意义(t=-8.243、-15.688、-20.193、-4.268、-4.768、-4.851、11.329、13.543、-5.399、-4.745、-4.598,均P<0.001)。两组术后Ⅰ~Ⅲ级并发症的比较差异无统计学意义(χ2=0.046,P=1.00)。结论:腹腔镜盆底三水平整体修复治疗男性直肠内脱垂的临床疗效优于经肛吻合器直肠切除术,是治疗直肠内脱垂的有效术式。Objective To compare the clinical efficacy of laparoscopic pelvic floor three-level internal repair and stapled transanal rectum resection(STARR)in the treatment of male patients with intrarectal prolapse.Mlethds A total of 101 male patients with rectal intrarectal prolapse from Feb 2013 to Oct 2017 were enrolled into this study.Fifty-two patient in group A received laparoscopic pelvie floor three-level internal repair,and 49 patients in group B received STARR.The Wexner incontinence scale(WIS),Wexner constipation scale(WCS)score,gastrointestinal quality of life index(GIQLI)and degree of internal rectal prolapse(DIRP)were systematically evaluated before surgery and 3 months,1 year and 3 years after surgery.Results There were no significant differences in age,BMI,number of bowel movements(BM),WIS,WCS,GIQLI and DIRP between the two groups before surgery(all P>0.05).The WIS,WCS,GIQLI and DIRP in 3 months,1year and 3 years after surgery in both two groups were significantly better than those before surgery(t=20.169,25.229,27.278,23.818,23.489,21.152,-3.550,-23.042,-22.901,82.852,40.915,30.010,11.323,13.237,11.452,19.473,18.647,17.108,-8.791,-5.254,-5.846,37.439,30.598,22.852,all P<0.001).The GIQLI in Group A was significantly better than that of group B at 1 year and 3 years after surgery(P<0.001)but close to that in Group B at 3 months after surgery(t=1.428,P=0.156).The WIS,WCS and DIRP in group A were significantly better than those in group B at 3 months,1 year and 3 years after surgery,with statistical significance(t=-8.243,-15.688,-20.193,-4.268,-4.768,-4.851,11.329,13.543,-5.399,-4.745,-4.598,all P<0.001).There was no signifcant difference in gradeⅠ-Ⅲcomplications between the two groups(χ2=0.046,P=1.00).Conclusion Laparoscopic pelvic floor three-level internal repair is more effective than transanal STARR in the treatment of male internal rectal prolapse.

关 键 词：直肠脱垂 骨盆底 修复外科手术 直肠切除术 腹腔镜 

分 类 号：R657.19[医药卫生—外科学]