Boccasanta P, Venturi M, Cioffi U, De Simone M, Strinna M, Salamina G, Raimondi A, Contessini-Avesani E
Department of General Surgery, University of Milan, Italy.
Minerva Chir. 2002 Apr;57(2):157-63.
The aim of this study was to confirm some selection criteria for the transrectal repair of the anterior rectocele and to compare our surgical results with those reported in the literature.
From January 1992 to December 1999, 30 females (mean age 52.9 years, range 28-70 yrs) affected by anterior rectocele were prospectively evaluated with a standard questionnaire, clinical examination, proctosigmoidoscopy, colonic transit time, dynamic defecography, anal EMG, anal manometry. Then, they were submitted to transrectal repair of rectocele with anterior plication of the rectal muscular wall. Fourteen (46.6%) of them were also submitted to perineal levatorplasty. Patients were followed postoperatively (mean 25.7 months) with the same standard questionnaire, clinical examination, defecography, and manometry. Results were tested by Fisher's Exact text, Wilcoxon's test, and "t"-test.
Rectal dyschezia, incomplete evacuation, digital help in defecating, mean stool frequency, and rectal bleeding significantly improved. After 3 months, 30% of patients had no complaints, 40% had only 1-2 episodes/month complaints, 13.3% had evacuation only using laxatives, and 16.6% were unchanged. Defecography showed a significant reduction of the rectocele in 70% of patients after 3 months. Manometric parameters were not significantly modified. Four (28.6%) out of 14 patients submitted to perineal levatorplasty complained of dyspareunia.
Our surgical results were comparable with those reported in the literature, with more than 80% of successful outcome. Preoperative clinical data and defecography were confirmed to be basic parameters in selecting patients for surgery. Colonic transit time, anal EMG, and anorectal manometry demonstrated to be useful to recognize conditions as slow colonic transit time, peripheral denervation, and reduced voluntary contraction that could lead to a less satisfactory outcome after surgery, and might benefit with a postoperative perineal rehabilitation by biofeedback and anal electrostimulations. The perineal levatorplasty is not suitable in young females, due to the risk of dyspareunia.
本研究旨在确定经直肠修复直肠前突的一些选择标准，并将我们的手术结果与文献报道的结果进行比较。
1992年1月至1999年12月，对30例直肠前突女性患者（平均年龄52.9岁，范围28 - 70岁）进行前瞻性评估，采用标准问卷、临床检查、直肠乙状结肠镜检查、结肠传输时间测定、动态排粪造影、肛门肌电图、肛门测压。然后，她们接受了直肠前壁折叠的经直肠直肠前突修复术。其中14例（46.6%）还接受了会阴提肌成形术。术后对患者进行随访（平均25.7个月），采用相同的标准问卷、临床检查、排粪造影和测压。结果采用Fisher精确检验、Wilcoxon检验和“t”检验进行分析。
直肠排便困难、排便不净、排便时需用手指辅助、平均排便频率和直肠出血均有显著改善。3个月后，30%的患者无不适，40%的患者每月仅有1 - 2次不适发作，13.3%的患者仅需使用泻药才能排便，16.6%的患者情况未改善。排粪造影显示，3个月后70%的患者直肠前突明显缩小。测压参数无显著改变。14例接受会阴提肌成形术的患者中有4例（28.6%）主诉性交困难。
我们的手术结果与文献报道的结果相当，成功率超过80%。术前临床数据和排粪造影被证实是选择手术患者的基本参数。结肠传输时间、肛门肌电图和肛肠测压显示有助于识别如结肠传输缓慢、周围神经病变和自主收缩减弱等情况，这些情况可能导致术后效果不理想，术后通过生物反馈和肛门电刺激进行会阴康复可能有益。由于存在性交困难的风险，会阴提肌成形术不适用于年轻女性。
