Lamah M, Ho J, Leicester R J
St. George's Hospital Medical School, London, UK.
Colorectal Dis. 2001 Nov;3(6):412-6. doi: 10.1046/j.1463-1318.2001.00245.x.
Transanal and transvaginal repair of rectocele have been advocated in the treatment of rectocele, with mixed results. The aim of this study was to assess our experience using anterior levatorplasty in the surgical management of rectocele.
Sixty of 90 women who had undergone anterior levatorplasty for rectocele over a seven year period were traced, and 44 (33 with rectocele only and 11 with rectocele and faecal incontinence) responded to a standardized questionnaire 6 months to 7 years (mean 3.5 years) after anterior levatorplasty. Results were expressed in general and specific improvement of symptoms and were classified as excellent, good, fair, or poor. The effects on social activities, sexual function, and employment were also assessed.
General satisfaction with the operation was rated as good or excellent in 27 of 33 (82%) and 18 of 24 (75%) patients with rectocele only at 2 and 3.2 years follow-up, respectively, and in 7 of 11 (64%) and 5 of 11 (45%) patients with rectocele and faecal incontinence at 2 and 4 years follow-up, respectively. 31 (70%) and 34 (77%) of all patients reported an improvement in sensation and the ability to defaecate, respectively. An improvement in social activities, sexual satisfaction and employment was noted in 10 of 21 (48%), 10 of 23 (43%), and 7 of 12 (58%) patients, respectively.
Anterior levatorplasty provides good short and long-term symptomatic improvement in patients with rectocele and avoids complications associated with rectal or vaginal approaches.
经肛门和经阴道修补直肠膨出一直被提倡用于治疗直肠膨出，但效果不一。本研究的目的是评估我们使用耻骨直肠肌前徙术治疗直肠膨出的经验。
在七年时间里，对90例行耻骨直肠肌前徙术治疗直肠膨出的女性患者中的60例进行随访，44例（33例仅患有直肠膨出，11例患有直肠膨出合并大便失禁）在耻骨直肠肌前徙术后6个月至7年（平均3.5年）回复了一份标准化问卷。结果以症状的总体和具体改善情况表示，并分为优、良、中、差。还评估了对社交活动、性功能和就业的影响。
仅患有直肠膨出的患者中，分别在术后2年和3.2年的随访中，33例中的27例（82%）和24例中的18例（75%）对手术的总体满意度被评为良好或优秀；患有直肠膨出合并大便失禁的患者中，分别在术后2年和4年的随访中，11例中的7例（64%）和11例中的5例（45%）对手术的总体满意度被评为良好或优秀。所有患者中，分别有31例（70%）和34例（77%）报告感觉和排便能力有所改善。分别有21例中的10例（48%）、23例中的10例（43%）和12例中的7例（58%）患者的社交活动、性满意度和就业情况有所改善。
耻骨直肠肌前徙术能为直肠膨出患者提供良好的短期和长期症状改善，并避免与经直肠或经阴道手术相关的并发症。
