Mercer-Jones M A, Sprowson A, Varma J S
Department of Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom.
Dis Colon Rectum. 2004 Jun;47(6):864-8. doi: 10.1007/s10350-004-0526-y. Epub 2004 Apr 19.
This study was designed to establish the safety and efficacy of transperineal mesh repair in patients with obstructed defecation caused by rectocele.
Between 1998 and 2002, 24 consecutive females with symptomatic rectocele were retrospectively reviewed after mesh repair of rectocele. Two patients had inadvertent rectal perforation during operation and had no mesh implantation. Of the remaining 22 patients, 14 had a prolene mesh implanted, and 8 had a Vipro II mesh implanted. Median age at the time of presentation was 55 (range, 28-66) years. Patients were selected for operation based on clinical and evacuation proctogram findings. All patients complained of incomplete rectal evacuation, and the majority complained of excessive straining, constipation, and the need for vaginal/perineal digital pressure to aid defecation. Patients were followed up in clinic at six weeks, and a telephone questionnaire was performed at a median time of 12.5 (range, 3-47) months. Functional/objective outcomes were assessed for the following five symptoms preoperatively and postoperatively: excessive straining, incomplete evacuation, perineal/vaginal digital pressure, vaginal bulging, and constipation (always, usually, occasionally, never). Subjective outcomes were assessed as excellent, good, moderate, or poor. In addition, patients were asked about preexisting and postoperative dyspareunia.
Objective outcomes based on symptoms showed an improvement in two or more symptoms in 20 patients (91 percent). For all symptoms, there was a significant reduction in mean values after repair. Subjective outcomes showed that 17 patients (77 percent) had a moderate/good/excellent result. Patients with abnormal preoperative colonic transit marker studies did as well as those who had no transit studies performed or those who had normal studies. Patients who did not vaginally digitate did as well as those who did not digitate. Only one patient complained of new onset dyspareunia. Two patients with sphincter defects on endoanal ultrasound had a sphincteroplasty performed (1 prerectocele repair and 1 at the same time). There were two superficial wound infections and one deep infection. All infections responded to antibiotic therapy. No mesh has been removed. Semiabsorbable mesh repair was superior to nonabsorbable mesh repair.
Transperineal mesh repair of symptomatic rectocele is a safe technique that avoids the anal dilation and sphincter injury associated with endorectal repair. Objective and subjective results are good in the majority of patients, although a longer follow-up is required to confirm no deterioration.
本研究旨在确定经会阴网状物修补术治疗直肠膨出所致排便梗阻患者的安全性和有效性。
回顾性分析1998年至2002年间连续24例因直肠膨出接受网状物修补术的有症状女性患者。2例患者在手术中意外发生直肠穿孔，未植入网状物。其余22例患者中，14例植入了普理灵网状物，8例植入了Vipro II网状物。就诊时的中位年龄为55岁（范围28 - 66岁）。根据临床和排粪造影结果选择患者进行手术。所有患者均主诉直肠排空不全，大多数患者主诉用力过度、便秘以及需要阴道/会阴指压辅助排便。患者在术后6周进行门诊随访，并在中位时间12.5个月（范围3 - 47个月）时进行电话问卷调查。术前和术后评估以下五种症状的功能/客观结果：用力过度、排空不全、会阴/阴道指压、阴道膨出和便秘（总是、通常、偶尔、从不）。主观结果评估为优、良、中或差。此外，询问患者术前和术后性交困难情况。
基于症状的客观结果显示，20例患者（91%）有两种或更多症状得到改善。对于所有症状，修补术后平均值均显著降低。主观结果显示，17例患者（77%）结果为中/良/优。术前结肠传输标记物研究异常的患者与未进行传输研究或研究结果正常的患者情况相同。未进行阴道指压的患者与进行阴道指压的患者情况相同。仅1例患者主诉新发性交困难。2例经肛管超声检查有括约肌缺陷的患者接受了括约肌成形术（1例在直肠膨出修补术前，1例同时进行）。发生2例表浅伤口感染和1例深部感染。所有感染对抗生素治疗均有反应。未取出任何网状物。半可吸收网状物修补术优于不可吸收网状物修补术。
经会阴网状物修补有症状的直肠膨出是一种安全的技术，可避免与直肠内修补相关的肛门扩张和括约肌损伤。大多数患者的客观和主观结果良好，尽管需要更长时间的随访以确认无病情恶化。
