Korenkov M, Junginger T
Klinik und Poliklinik für Allgemein- und Abdominalchirurgie, Johannes-Gutenberg-Universität Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany.
Zentralbl Chir. 2005 Dec;130(6):544-9. doi: 10.1055/s-2005-918195.
Despite progress in modern surgery, the choice of the surgical procedure of rectal prolapse is regarded with controversy. Selection criteria between the abdominal or perineal approach or between rectopexy and resection rectopexy are not yet proven. This article gives a review of the literature about rectal prolapse and an analysis of the outcome of posterior rectopexy and resection rectopexy--partly conventionally and partly laparoscopically--in 25 patients with rectal prolapse III degrees and IV degrees. All except for one patient were examined during a mean follow-up of 5.5 (3.1) years for the rectopexy group and 2.1 (0.7) years for the resection rectopexy group. Recurrence occurred in one patient in each group respectively. There was no significant difference concerning the continence function (p = 0.32) and constipation (p = 0.36) between both groups. No mesh-related complications such as infection, fistula or rectum stenosis were observed. According to the review of the literature and our data, we believe that the choice of the operative procedure for rectal prolapse should be based on individual criteria. Fit patients should be offered laparoscopic procedures such as resection rectopexy and rectopexy without colonic resection.
尽管现代外科手术取得了进展，但直肠脱垂手术方式的选择仍存在争议。腹部或会阴入路之间，以及直肠固定术和切除直肠固定术之间的选择标准尚未得到证实。本文回顾了关于直肠脱垂的文献，并分析了25例Ⅲ度和Ⅳ度直肠脱垂患者行后路直肠固定术和切除直肠固定术（部分采用传统方法，部分采用腹腔镜方法）的结果。直肠固定术组平均随访5.5（3.1）年，切除直肠固定术组平均随访2.1（0.7）年，除1例患者外，所有患者均接受了检查。每组分别有1例患者复发。两组在控便功能（p = 0.32）和便秘（p = 0.36）方面无显著差异。未观察到与补片相关的并发症，如感染、瘘管或直肠狭窄。根据文献回顾和我们的数据，我们认为直肠脱垂手术方式的选择应基于个体标准。适合的患者应选择腹腔镜手术，如切除直肠固定术和不进行结肠切除的直肠固定术。
