经自然腔道取标本手术在直肠脱垂治疗中的应用及近期疗效分析  

The application of natural orifice specimen extraction surgery in the treatment of rectal prolapse

作　　者：唐瑞雪 梁延洋 武祖印 张春旭 TANG Ruixue;LIANG Yanyang;WU Zuyin(Graduate School of Xinxiang Medical College,Zhengzhou 450003,China;Department of General Surgery,the 988th Hospital of the Joint Logistic Support Force of PLA)

机构地区：[1]新乡医学院研究生院,河南郑州450003 [2]中国人民解放军联勤保障部队第九八八医院普通外科

出　　处：《腹腔镜外科杂志》2024年第3期205-209,221,共6页Journal of Laparoscopic Surgery

基　　金：河南省医学科技攻关计划科研项目(SB201903034)。

摘　　要：目的:探讨经自然腔道取标本手术治疗直肠脱垂的应用价值及近期疗效分析。方法:回顾分析2019年1月至2023年3月收治的41例直肠脱垂患者的临床资料。其中15例行经自然腔道取标本手术(观察组),26例行传统腹腔镜手术(对照组)。对比分析两组手术时间、术中出血量、术后住院时间、术后疼痛评分、术后并发症及复发率,评估肛门括约肌功能、Wexner肛门失禁评分及便秘评分。结果:观察组与对照组术中出血量差异无统计学意义[48(42,50)mL vs. 47(45,50)mL,P>0.05],手术时间[(147.20±5.51)min vs.(132.61±5.88)min]、住院时间[7(6,8)d vs.12(10,13)d]、术后疼痛评分[2(1,3)分vs.5(4,6)分]差异有统计学意义(P<0.05)。术后两组肛门括约肌评分、Wexner肛门失禁评分、Wexner便秘评分与术前相比均降低,差异有统计学意义(P<0.05),两组间差异无统计学意义(P>0.05)。对照组发生3例腹壁辅助切口脂肪液化。术后无围手术期死亡,随访6个月无复发病例。结论:经自然腔道取标本手术应用于直肠脱垂的治疗安全、可行,具有康复快、术后疼痛轻、便秘与肛门失禁明显改善、复发率低的优点,值得临床推广应用。Objective:To investigate the clinical value and short-term efficacy of natural orifice specimen extraction surgery in the treatment of rectal prolapse.Methods:The clinical data of 41 patients with rectal prolapse from Jan.2019 to Mar.2023 were retrospectively analyzed.15 patients underwent natural orifice specimen extraction surgery(observation group),26 patients underwent traditional laparoscopic surgery(control group).Operation time,intraoperative blood loss,postoperative hospital stay,postoperative pain score,postoperative complications and the recurrence rate were compared between the two groups.Anal sphincter function,Wexner anal incontinence and constipation score were evaluated.Results:There was no significant difference in intraoperative blood loss between the observation group and the control group[48(42,50)mL vs.47(45,50)mL,P>0.05].There were significant differences in the operation time[(147.20±5.51)min vs.(132.61±5.88)min],hospital stay[7(6,8)d vs.12(10,13)d]and postoperative pain score[2(1,3)vs.5(4,6)]between the observation group and the control group(P<0.05).The postoperative anal sphincter score,Wexner anal incontinence score and Wexner constipation score of the observation group and the control group were significantly lower than those before operation(P<0.05),but there was no significant difference between the two groups(P>0.05).In the control group,3 patients suffered from fat liquefaction in the abdominal auxiliary incision.There were no perioperative death and no recurrence in the postoperative follow-up of 6 months.Conclusions:The application of natural orifice specimen extraction surgery in the treatment of rectal prolapse is safe and feasible,with the advantages of rapid recovery,mild postoperative pain,significant improvement of constipation and anal incontinence,and low recurrence rate,which is worthy of clinical promotion.

关 键 词：直肠脱垂 经自然腔道取标本手术 乙状结肠部分切除术 腹腔镜检查 

分 类 号：R657.19[医药卫生—外科学]