Hirst G R, Hughes R J, Morgan A R, Carr N D, Patel B, Beynon J
Colorectal Unit, Singleton Hospital, Swansea, UK.
Colorectal Dis. 2005 Mar;7(2):159-63. doi: 10.1111/j.1463-1318.2004.00768.x.
Obstructed defaecation is a complex disorder that poses serious management challenges. The purpose of this study is to review the functional results of surgery in women undergoing rectocele repair for obstructed defaecation, and in a targeted subgroup in which the rectocele was the only identifiable cause of their symptoms.
All case notes were reviewed. Demographic details, preoperative symptoms, details of previous pelvic surgery, radiological and anorectal physiology results, operative procedure, post operative symptoms, length of follow-up and details of further pelvic reconstructive surgery were recorded. To enter the targeted group, patients (i) had not undergone previous pelvic surgery, (ii) had presented with obstructive defaecation, (iii) had a proctogram that demonstrated a rectocele with no or partial intrarectal intussusception and (iv) had no other functional abnormality in colonic transit studies, endoanal ultrasound or anorectal physiology.
Eighty-two case notes were reviewed. All experienced obstructed defaecation. Forty-two women underwent a per-anal plication of the rectocele, 33 had a transperineal plication and levatorplasty and seven a mesh repair. A total of 63 (77%) women were pleased with the result, though symptoms later returned in 17 (27%) of them. 26 (31%) had further surgery in an attempt to improve their defaecatory difficulties. Sixteen women were eligible for the targeted group. All had a good early result though symptoms returned in three women. Two (12%) had further surgery.
Careful preoperative patient selection is vital to improve outcomes. Preoperative counselling of all patients undergoing rectocele repair is of extreme importance, in particular explaining the evolving nature of pelvic floor dysfunction and the possible need for further reconstructive surgery.
排便障碍是一种复杂的病症，给治疗带来了严峻挑战。本研究旨在回顾因排便障碍接受直肠膨出修补术的女性患者，以及直肠膨出是唯一可识别症状病因的特定亚组患者的手术功能结果。
回顾了所有病例记录。记录了人口统计学细节、术前症状、既往盆腔手术细节、放射学和肛肠生理学结果、手术过程、术后症状、随访时间以及进一步盆腔重建手术的细节。要进入目标组，患者需满足以下条件：（i）既往未接受过盆腔手术；（ii）出现排便障碍；（iii）直肠造影显示有直肠膨出且无或仅有部分直肠内套叠；（iv）结肠传输试验、肛管超声或肛肠生理学检查无其他功能异常。
回顾了82份病例记录。所有患者均有排便障碍。42名女性接受了经肛门直肠膨出折叠术，33名接受了经会阴折叠术和提肛肌成形术，7名接受了网片修补术。共有63名（77%）女性对结果满意，不过其中17名（27%）后来症状复发。26名（31%）患者接受了进一步手术，试图改善排便困难。16名女性符合目标组标准。所有患者早期效果良好，但有3名女性症状复发。2名（12%）患者接受了进一步手术。
仔细的术前患者选择对于改善治疗效果至关重要。对所有接受直肠膨出修补术的患者进行术前咨询极为重要，尤其要解释盆底功能障碍的发展性质以及可能需要进一步进行重建手术的情况。
