Lazorthes F, Liagre A, Iovino F
Service de Chirurgie Digestive, Hôpital Purpan - Toulouse.
J Chir (Paris). 2000 Apr;137(2):76-81.
Rectal prolapse and rectal intussuception correspond to two stages of the same disease. Rectal prolapse is unusual but requires surgical treatment. Abdominal rectopexy is the most effective procedure but increases the risk of postoperative constipation. This risk decreases when the lateral sides are not touched during rectal dissection. The Delorme procedure is associated with a higher rate of recurrence and must be reserved for patients presenting a high risk of postoperative complications. Rectal intussuception is more frequent and is pathological only when arising in the anal sphincter. Rectal intussuception may lead to solitary rectal ulcer and has in this case to be treated by rectopexy. Rectal intussuception involvement in terminal constipation is not yet proved. Internal mucosectomy seems to be the best treatment for terminal constipation.
直肠脱垂和直肠套叠是同一疾病的两个阶段。直肠脱垂不常见,但需要手术治疗。经腹直肠固定术是最有效的手术方式,但会增加术后便秘的风险。当直肠游离时不触碰两侧,这种风险会降低。德洛姆手术复发率较高,必须仅用于术后并发症风险高的患者。直肠套叠更常见,仅在肛门括约肌出现时才具有病理性。直肠套叠可能导致孤立性直肠溃疡,在这种情况下需通过直肠固定术治疗。直肠套叠与终末期便秘的关联尚未得到证实。内黏膜切除术似乎是终末期便秘的最佳治疗方法。