Douard Richard, Frileux Pascal, Brunel Martin, Attal Emmanuel, Tiret Emmanuel, Parc Rolland
Department of Gastrointestinal Surgery, Saint-Antoine University Hospital (Assistance Publique-Hôpitaux de Paris) and Faculty of Medicine Paris VI, Paris, France.
Dis Colon Rectum. 2003 Aug;46(8):1089-96. doi: 10.1007/s10350-004-7285-7.
The aim of this study was to assess functional results after Orr-Loygue transabdominal rectopexy for complete rectal prolapse.
Thirty-one consecutive patients operated on for complete rectal prolapse between 1995 and 1998 were evaluated preoperatively and postoperatively with regard to anal incontinence, constipation, evacuation difficulties, and overall satisfaction with a standardized questionnaire. Anal continence assessment was based on a clinical scoring system.
After a mean follow-up of 28 +/- 13 (range, 12-57) months, no prolapse recurred. Preoperative and postoperative rates of incontinence were 81 percent (25/31) and 55 percent (17/31), respectively (P < 0.03). Continence improved in 24 (96 percent) of the 25 patients who were incontinent before surgery. The mean incontinence score decreased from 11.7 +/- 7.8 preoperatively to 3.2 +/- 4.2 postoperatively (P < 0.001). The self-reported constipation rate was 61 percent (19/31) before surgery and 71 percent (22/31) after surgery (P = nonsignificant). Constipation appeared or worsened in 16 patients (52 percent), whereas it disappeared or improved in 8 (26 percent; P = nonsignificant). Evacuation difficulties increased significantly after surgery from 23 percent (7/31) to 61 percent (19/31; P < 0.003). Ninety-seven percent of patients reported good or very good satisfaction.
Transabdominal Orr-Loygue rectopexy resulted in improved continence and a high satisfaction level. Despite a significant postoperative increase in evacuation difficulties, only a 10 percent (nonsignificant) increase in the self-reported constipation rate was observed.
本研究旨在评估经腹Orr-Loygue直肠固定术治疗完全性直肠脱垂后的功能结果。
对1995年至1998年间连续接受完全性直肠脱垂手术的31例患者，术前和术后采用标准化问卷评估肛门失禁、便秘、排便困难及总体满意度。肛门控便能力评估基于临床评分系统。
平均随访28±13（范围12 - 57）个月后，无脱垂复发。术前和术后失禁率分别为81%（25/31）和55%（17/31）（P < 0.03）。术前失禁的25例患者中有24例（96%）控便能力改善。失禁平均评分从术前的11.7±7.8降至术后的3.2±4.2（P < 0.001）。自我报告的便秘率术前为61%（19/31），术后为71%（22/31）（P无统计学意义）。16例患者（52%）便秘出现或加重，而8例患者（26%）便秘消失或改善（P无统计学意义）。术后排便困难从23%（7/31）显著增加至61%（19/31；P < 0.003）。97%的患者报告满意度良好或非常好。
经腹Orr-Loygue直肠固定术可改善控便能力并提高满意度。尽管术后排便困难显著增加，但自我报告的便秘率仅增加了10%（无统计学意义）。
