Williams N S, Dvorkin L S, Giordano P, Scott S M, Huang A, Frye J N R, Allison M E, Lunniss P J
Centre for Academic Surgery, 4th floor Alexandra Wing, The Royal London Hospital, Whitechapel, London E1 1BB, UK.
Br J Surg. 2005 May;92(5):598-604. doi: 10.1002/bjs.4904.
The results of conventional treatment for rectal intussusception and rectocele are unpredictable. The aim was to develop a less invasive surgical approach and to evaluate outcome in selected patients.
Seventeen patients (13 women; median age 47 (range 20-67) years) with rectal evacuatory dysfunction and rectal intussusception, 13 of whom had a rectocele, were selected. The intussusception was corrected by external pelvic suspension of the rectum, using collagen strips attached to the rectal wall and pubis. The rectocele was repaired with a collagen patch. Patients were assessed before and 6 months after surgery by symptom and quality of life questionnaires, anorectal physiological investigation and proctography, and were followed up for a median of 12 months.
Sepsis requiring exploration occurred in two patients but there was no extrusion or need to remove the collagen. Of the 15 patients assessed after surgery, total symptom scores were significantly decreased (P < 0.001) and quality of life scores improved (P < 0.001). Proctographically, the degree of intussusception was improved in ten patients; six patients had normal postoperative proctograms. The rectocele was reduced in size in all patients, and was not demonstrable in eight.
An effective procedure for rectal intussusception and rectocele has been developed in a selected group of patients with marked evacuatory symptoms.
直肠套叠和直肠膨出的传统治疗结果不可预测。目的是开发一种侵入性较小的手术方法，并评估特定患者的治疗效果。
选择17例（13例女性；中位年龄47岁（范围20 - 67岁））有直肠排空功能障碍和直肠套叠的患者，其中13例有直肠膨出。通过将胶原条附着于直肠壁和耻骨进行直肠外盆腔悬吊来纠正套叠。用胶原补片修复直肠膨出。术前及术后6个月通过症状和生活质量问卷、肛肠生理检查和直肠造影对患者进行评估，并进行中位时间为12个月的随访。
2例患者发生需要探查的脓毒症，但未出现胶原条挤出或需要移除的情况。在术后评估的15例患者中，总症状评分显著降低（P < 0.001），生活质量评分提高（P < 0.001）。直肠造影显示，10例患者的套叠程度改善；6例患者术后直肠造影正常。所有患者的直肠膨出大小均减小，8例患者的直肠膨出未显示。
在一组有明显排空症状的特定患者中，已开发出一种治疗直肠套叠和直肠膨出的有效方法。
