Basse Linda, Billesbølle Per, Kehlet Henrik
Unit of Gastroenterology, Surgical Section, University of Copenhagen, Hvidovre University Hospital, Hvidovre, Denmark.
Dis Colon Rectum. 2002 Feb;45(2):195-9. doi: 10.1007/s10350-004-6145-9.
Abdominal rectopexy without sigmoid resection is usually associated with a hospital stay of four to ten days. Recent developments have shown that a multimodal rehabilitation program with epidural analgesia and early oral feeding and mobilization will reduce hospital stay after colonic resection. The aim of this study was to describe the results after abdominal rectopexy with a multimodal rehabilitation program.
Thirty-one consecutive patients with rectal prolapse, median age 69 (range, 24-85) years and including 14 patients of American Society of Anesthesiologists physical status III to IV, were scheduled for abdominal rectopexy with a multimodal rehabilitation program including 48 hours thoracic epidural analgesia or patient-controlled anesthesia (3 patients), early oral nutrition and mobilization, and a planned two-day postoperative hospital stay. Follow-up was done at two months postoperatively.
All patients except one tolerated normal diet and were mobilized to the same level as before surgery on the first postoperative day. Bowel movement was reestablished at a median of Day 2, and median postoperative hospital stay was three (mean, 4.4) days. At two months follow-up 16 percent were incontinent vs. 74 percent before surgery. Constipation was noted in 43 percent before surgery vs. 28 percent at two months follow-up.
Median hospital stay after abdominal rectopexy may be reduced to three days with postoperative multimodal rehabilitation.
不进行乙状结肠切除术的腹部直肠固定术通常需要住院四至十天。最近的进展表明,采用硬膜外镇痛、早期口服喂养和活动的多模式康复计划将减少结肠切除术后的住院时间。本研究的目的是描述采用多模式康复计划进行腹部直肠固定术后的结果。
连续31例直肠脱垂患者,中位年龄69岁(范围24 - 85岁),其中包括14例美国麻醉医师协会身体状况为III至IV级的患者,计划采用多模式康复计划进行腹部直肠固定术,该计划包括48小时胸段硬膜外镇痛或患者自控麻醉(3例患者)、早期口服营养和活动,以及计划术后住院两天。术后两个月进行随访。
除1例患者外,所有患者在术后第一天都能耐受正常饮食,并能恢复到与手术前相同的活动水平。排便中位数在术后第2天恢复,术后中位住院时间为3天(平均4.4天)。在两个月的随访中,16%的患者存在大便失禁,而术前为74%。术前43%的患者有便秘,而在两个月随访时为28%。
采用术后多模式康复,腹部直肠固定术后的中位住院时间可缩短至3天。