Grandjean J P, Seket B, Galaup J P, Leriche B, Lapray J F, Daville O, Chircop R, Dubernard P
Centre lyonnais de coloproctologie, 1, rue Laborde, 69500 Bron, France.
Ann Chir. 2004 Mar;129(2):87-93. doi: 10.1016/j.anchir.2003.12.014.
To report the results of abdominal promontory rectopexy and douglassectomy in the management of rectocele and enterocele.
Between 1992 and 2002, 72 patients were operated by one colorectal surgeon. Laparotomy was used in 37 cases between 1992 and 2001 and the laparoscopic approach in 35 cases from 1995 to 2002. Promontory rectal fixation required only one mesh secured between the anterolateral right side of the rectum and the lumbosacral ligament. The same mesh was used to fix the vagina or the cervix. Combined therapeutic or prophylactic urinary interventions are frequent in the series.
The follow-up was more than one year in 63 patients with a mean value of 58 months with no patient lost. Recurrence of posterior vaginal prolapse was noted in only two cases. Dyschesia and urinary incontinence were improved respectively in 80 and 70% of the cases and a significant improvement in anal incontinence was observed in 95% of the patients.
The abdominal way allows a suitable treatment in patients with advanced stage rectocele and enterocele and evidence of pelvic organ prolapse. The laparoscopic approach is superior in terms of morbidity and functional results.
报告腹骶直肠固定术和Douglas窝切除术治疗直肠膨出和肠膨出的结果。
1992年至2002年间，由一位结直肠外科医生为72例患者实施手术。1992年至2001年间37例采用开腹手术，1995年至2002年间35例采用腹腔镜手术。骶前直肠固定术仅需一块补片固定于直肠右前外侧与腰骶韧带之间。同一块补片用于固定阴道或宫颈。该系列中联合治疗性或预防性泌尿干预很常见。
63例患者随访超过1年，平均58个月，无患者失访。仅2例出现阴道后壁脱垂复发。排便困难和尿失禁分别在80%和70%的病例中得到改善，95%的患者肛门失禁有显著改善。
腹部手术方式可为晚期直肠膨出和肠膨出及盆腔器官脱垂患者提供合适的治疗。腹腔镜手术在发病率和功能结果方面更具优势。
