腹腔镜直肠腹侧补片固定术加肛门括约肌成型术治疗完全性直肠脱垂的疗效分析  

Laparoscopic ventral mesh rectopexy and anal sphincter plasty for complete rectal prolapse

作　　者：张玉茹[1] 曹迪 任春成 王凯[1] 安宁[1] 王敏[1] 张莉[1] 牛烁 Zhang Yuru;Cao Di;Ren Chuncheng;Wang Kai;An Ning;Wang Min;Zhang Li;Niu Shuo(Department of General Surgery,Beijing Erlonglu Hospital,Beijing 100120,China)

机构地区：[1]北京市肛肠医院(北京市二龙路医院)结直肠肛门外科,北京100120

出　　处：《中华普通外科杂志》2024年第3期207-210,共4页Chinese Journal of General Surgery

基　　金：北京市肛肠医院(北京市二龙路医院)院内课题(ZG20210101)。

摘　　要：目的评估行腹腔镜直肠腹侧补片固定术(LVMR)+肛门括约肌成型术治疗完全性直肠脱垂的安全性和有效性。方法回顾性分析2018年1月1日至2022年12月31日在北京市肛肠医院(北京市二龙路医院)诊断为完全性直肠脱垂并接受LVMR+肛门括约肌成型术45例患者的临床资料。结果本组中无1例与LVMR相关的死亡患者。随访时间8~76个月,中位随访时间为59个月,复发2例,复发率4%。合并有便失禁症状患者的术前平均Jorge-Wexner便失禁评分为13.8±2.0,术后3、6、12、36、60个月的平均Jorge-Wexner便失禁评分分别为7.5±1.5、5.3±1.3、4.3±1.1、2.8±1.0、1.8±0.5,差异均有统计学意义,均P<0.001。合并有便秘症状患者的术前平均Wexner便秘评分为15.7±1.5,术后3、6、12、36、60个月的平均Wexner便秘评分分别为9.0±1.8、6.8±1.5、5.2±1.4、4.1±0.7、2.0±0.0,差异均有统计学意义,均P<0.001。结论LVMR+肛门括约肌成型术对治疗完全性直肠脱垂是安全有效的,肛门括约肌成形术可有效改善肛门功能。Objective To evaluate the safety and effectiveness of laparoscopic ventral mesh rectopexy(LVMR)+anal sphincter plasty for complete rectal prolapse.Methods From Jan 1,2018 to Dec 31,2022,45 patients with complete rectal prolapse diagnosed in Beijing Erlong Road Hospital received laparoscopic ventral mesh rectopexy+anal sphincter plasty were included in this study.Result There was no mortality rate associated with LVMR in this study cohort.The follow-up period was 8-76 months,with a median follow-up period of 59 months.There were 2 cases of recurrence,with a recurrence rate of 4%.Patients with concomitant fecal incontinence symptoms had a preoperative Jorge Wexner fecal incontinence score of 13.8±2.0,and postoperative Jorge Wexner fecal incontinence scores of 7.5±1.5,5.3±1.3,4.3±1.1,2.8±1.0,and 1.8±0.5 at 3,6,12,36,and 60 months,respectively,all P<0.001.Patients with concomitant constipation had a preoperative Wexner constipation score of 15.7±1.5,and a postoperative Wexner constipation score of 9.0±1.8,6.8±1.5,5.2±1.4,4.1±0.7,2.0±0.0 at 3,6,12,36,and 60 months,respectively,all P<0.001.Conclusions LVMR+anal Sphincter plasty is safe and effective for the treatment of complete rectal prolapse,and there are few complications related to biological patches.Anal sphincter plasty can effectively improve anal function.

关 键 词：直肠脱垂 复发 腹腔镜 生物补片 

分 类 号：R656[医药卫生—外科学]