Bruch H P, Herold A, Schiedeck T, Schwandner O
Department of Surgery, Medical University of Luebeck, Germany.
Dis Colon Rectum. 1999 Sep;42(9):1189-94; discussion 1194-5. doi: 10.1007/BF02238572.
The aim of this study was to assess the outcome of both laparoscopic suture rectopexy and resection-rectopexy in the treatment of complete and incomplete rectal prolapse, outlet obstruction, or both.
Data from surgery were collected prospectively. Semiannual follow-up was performed by assessment of recurrence, continence, and constipation using patients' history, physical examination, continence score, and anorectal manometry. Statistical analysis was performed by chi-squared test and Student's t-test (P < 0.05 was accepted as statistically significant).
Between September 1992 and February 1997, 72 patients (68 females) with a mean age of 62 (range, 23-88) years were treated laparoscopically. Indications for surgery were rectal prolapse in 21 patients, rectal prolapse combined with outlet obstruction in 36 patients, and outlet obstruction alone in 15 patients. Standard procedure was a laparoscopic suture rectopexy. A sigmoid resection was added in 40 patients. Mean duration of surgery was 227 (range, 125-360) minutes for rectopexy and 258 (range, 150-380) minutes for resection-rectopexy. Conversion was necessary in 1.4 percent (n = 1). Overall complication rate was 9.7 percent (n = 7) and mortality rate was 0 percent. Mean postoperative hospitalization was 15 (range, 6-47) days. All patients with a minimal follow-up of two years (n = 53) could be enrolled in a prospective follow-up study (mean follow-up, 30 months). No recurrence of rectal prolapse had to be recognized. Sixty-four percent of patients with incontinence before surgery were continent or had improved continence. In patients experiencing constipation preoperatively, constipation was improved or completely removed in 76 percent. No additional symptoms of constipation occurred after surgery.
Laparoscopic procedures in the treatment of pelvic floor disorders, e.g., rectal prolapse or outlet obstruction, lead to acceptable functional results. However, follow-up has to be extended and long-term results of recurrence, continence, and constipation have to be evaluated.
本研究旨在评估腹腔镜缝合直肠固定术和切除 - 直肠固定术治疗完全性和不完全性直肠脱垂、出口梗阻或两者兼有的疗效。
前瞻性收集手术数据。通过询问患者病史、体格检查、控便评分和肛肠测压法，每半年对复发、控便和便秘情况进行随访评估。采用卡方检验和学生 t 检验进行统计分析（P < 0.05 被认为具有统计学意义）。
1992 年 9 月至 1997 年 2 月期间，72 例患者（68 例女性）接受了腹腔镜手术治疗，平均年龄 62 岁（范围 23 - 88 岁）。手术指征为：21 例直肠脱垂患者，36 例直肠脱垂合并出口梗阻患者，15 例单纯出口梗阻患者。标准手术为腹腔镜缝合直肠固定术。40 例患者加做了乙状结肠切除术。直肠固定术的平均手术时间为 227 分钟（范围 125 - 360 分钟），切除 - 直肠固定术的平均手术时间为 258 分钟（范围 150 - 380 分钟）。1.4%（n = 1）的患者需要中转手术。总体并发症发生率为 9.7%（n = 7），死亡率为 0%。术后平均住院时间为 15 天（范围 6 - 47 天）。所有至少随访两年的患者（n = 53）均可纳入前瞻性随访研究（平均随访 30 个月）。未发现直肠脱垂复发。术前有控便障碍的患者中，64%恢复了控便能力或控便情况有所改善。术前有便秘的患者中，76%的便秘情况得到改善或完全消除。术后未出现新的便秘症状。
腹腔镜手术治疗盆底疾病，如直肠脱垂或出口梗阻，可获得可接受的功能结果。然而，随访时间必须延长，且必须评估复发、控便和便秘的长期结果。
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