Altomare Donato F, Rinaldi Marcella, Veglia Antonella, Petrolino Maria, De Fazio Michele, Sallustio Pierluca
Department of Emergency and Organ Transplantation, General Surgery and Liver Transplantation Units, University of Bari, Policlinico, piazza G. Cesare 11, 70124 Bari, Italy.
Dis Colon Rectum. 2002 Nov;45(11):1549-52. doi: 10.1007/s10350-004-6465-9.
The aim of this study was to present a new technique for treatment of disabling rectocele when associated with internal mucosal prolapse or hemorrhoids using a 33-mm circular stapler.
Eight female patients complaining of obstructed defecation because of distention rectocele associated with internal mucosal prolapse or hemorrhoids and perineal descent entered the study. The rectovaginal septum was opened by diathermy up to the end of the rectal wall weakness. The perineal wound and the anus were held open by a self-retractor. Using a transparent anoscope (PPH 01 system), 2 mucosal pursestrings were prepared 5 and 8 to 9 cm distant from the dentate line. Posteriorly, only the submucosa was included in the pursestring; anteriorly, it included the rectal wall, which was kept separate from the vaginal wall. A transanal 33-mm circular stapler was then used to close the rectocele and treat the mucosal prolapse. Before closing the perineum a levatorplasty was fashioned.
One patient had a vaginal tear during dissection of the septum, which healed spontaneously in one month. No other complications were recorded. Postoperative defecography showed correction of the rectocele and the posterior rectal prolapse in all patients. In two of them, a small lateral diverticulum could be seen, although this was asymptomatic. After a median follow-up of 12 months, all had significantly improved defecation (chronic constipation score dropped from 14.3 to 5, P < 0.04).
Combined perineal and endorectal stapler repair of rectocele may be a useful new surgical tool for correcting distention rectocele associated with mucosal prolapse or hemorrhoids and perineal descent in selected patients. A longer follow-up on a larger number of patients is needed to confirm these preliminary results.
本研究旨在介绍一种使用33毫米圆形吻合器治疗伴有内痔黏膜脱垂或痔疮的致残性直肠膨出的新技术。
八名女性患者因伴有内痔黏膜脱垂或痔疮及会阴下降的直肠膨出导致排便梗阻而进入本研究。通过电灼打开直肠阴道隔直至直肠壁薄弱处的末端。使用自固定牵开器保持会阴伤口和肛门开放。使用透明肛门镜（PPH 01系统），在距齿状线5厘米以及8至9厘米处制备两条黏膜荷包缝线。在后方，荷包缝线仅包含黏膜下层；在前方，它包含直肠壁，直肠壁与阴道壁保持分开。然后使用经肛门33毫米圆形吻合器闭合直肠膨出并治疗黏膜脱垂。在闭合会阴之前进行提肛肌成形术。
一名患者在分离隔时出现阴道撕裂，一个月后自行愈合。未记录其他并发症。术后排粪造影显示所有患者的直肠膨出和直肠后壁脱垂均得到矫正。其中两名患者可见一个小的侧方憩室，尽管无症状。中位随访12个月后，所有患者的排便情况均有显著改善（慢性便秘评分从14.3降至5，P<0.04）。
会阴联合直肠内吻合器修复直肠膨出可能是一种有用的新手术工具，用于矫正选定患者中伴有黏膜脱垂或痔疮及会阴下降的直肠膨出。需要对更多患者进行更长时间的随访以证实这些初步结果。
