Pikarsky A J, Joo J S, Wexner S D, Weiss E G, Nogueras J J, Agachan F, Iroatulam A
Department of Colorectal Surgery, Cleveland Clinic Florida, Fort Lauderdale 33309, USA.
Dis Colon Rectum. 2000 Sep;43(9):1273-6. doi: 10.1007/BF02237435.
The aim of this study was to assess the clinical and functional outcome of surgery for recurrent rectal prolapse and compare it with the outcome of patients who underwent primary operation for rectal prolapse.
All patients who underwent surgery for rectal prolapse were evaluated for age, gender, procedure, anorectal manometry and electromyography findings, and morbidity. The results for patients who underwent surgery for recurrent rectal prolapse were compared with a group of patients matched for age, gender, surgeon, and procedure who underwent primary operations for rectal prolapse.
A total of 115 patients underwent surgery for rectal prolapse. Twenty-seven patients, 10 initially operated on at this institution and 17 operated on elsewhere, underwent surgery for recurrent rectal prolapse. These 27 patients were compared with 27 patients with primary rectal prolapse operated on in our department. In the recurrent rectal prolapse group, prior surgery included rectopexy in 7 patients, Delorme's procedure in 7 patients, perineal rectosigmoidectomy in 7 patients, anal encirclement procedure in 4 patients, and resection rectopexy in 2 patients. Operations performed for recurrence were perineal rectosigmoidectomy in 14 patients, resection rectopexy in 8 patients, rectopexy in 2 patients, pelvic floor repair in 2 patients, and Delorme's procedure in 1 patient. There were no statistically significant differences between the groups in preoperative incontinence score (recurrent rectal prolapse, 13.6 +/- 7.8 vs. rectal prolapse, 12.7 +/- 7.2; range, 0-20) or manometric or electromyography findings, and there were no significant differences in mortality (0 vs. 3.7 percent), mean hospital stay (5.4 +/- 2.5 vs. 6.9 +/- 2.8 days), anastomotic complications (anastomotic stricture (0 vs. 7.4 percent), anastomotic leak (3.7 vs. 3.7 percent) and wound infection (3.7 vs. 0 percent), postoperative incontinence score (2.8 +/- 4.8 vs. 1.5 +/- 2.7), or recurrence rate (14.8 vs. 11.1 percent) between the two groups at a mean follow-up of 23.9 (range, 6-68) and 22 (range, 5-55) months, respectively. The overall success rate for recurrent rectal prolapse was 85.2 percent.
The outcome of surgery for rectal prolapse is similar in cases of primary or recurrent prolapse. The same surgical options are valid in both scenarios.
本研究旨在评估复发性直肠脱垂手术的临床及功能结果，并与接受直肠脱垂初次手术患者的结果进行比较。
对所有接受直肠脱垂手术的患者进行年龄、性别、手术方式、肛门直肠测压及肌电图检查结果和发病率评估。将复发性直肠脱垂手术患者的结果与一组年龄、性别、手术医生和手术方式相匹配的直肠脱垂初次手术患者进行比较。
共有115例患者接受了直肠脱垂手术。27例患者接受了复发性直肠脱垂手术，其中10例最初在本机构接受手术，17例在其他地方接受手术。将这27例患者与在我科接受原发性直肠脱垂手术的27例患者进行比较。在复发性直肠脱垂组中，既往手术包括7例直肠固定术、7例德洛姆手术、7例会阴部直肠乙状结肠切除术、4例肛门环扎术和2例直肠切除直肠固定术。针对复发进行的手术包括14例会阴部直肠乙状结肠切除术、8例直肠切除直肠固定术、2例直肠固定术、2例盆底修复术和1例德洛姆手术。两组术前失禁评分（复发性直肠脱垂，13.6±7.8 vs. 直肠脱垂，12.7±7.2；范围0 - 20）、测压或肌电图检查结果无统计学显著差异，死亡率（0 vs. 3.7%）、平均住院天数（5.4±2.5 vs. 6.9±2.8天）、吻合口并发症（吻合口狭窄（0 vs. 7.4%）、吻合口漏（3.7 vs. 3.7%）和伤口感染（3.7 vs. 0%））、术后失禁评分（2.8±4.8 vs. 1.5±2.7）或复发率（14.8 vs. 11.1%）在平均随访23.9（范围6 - 68）个月和22（范围5 - 55）个月时两组间也无显著差异。复发性直肠脱垂的总体成功率为85.2%。
原发性或复发性直肠脱垂手术的结果相似。两种情况下相同的手术选择都是有效的。
