Petersen S, Hellmich G, Schuster A, Lehmann D, Albert W, Ludwig K
Department of General and Abdominal Surgery, Dresden-Friedrichstadt Hospital, Dresden, Germany.
Dis Colon Rectum. 2006 May;49(5):685-9. doi: 10.1007/s10350-006-0512-7.
Stapled transanal rectal resection recently became a recommended surgical procedure for obstructed defecation syndrome. One problem when using a transanal stapling device for rectal surgery is the potential threat to structures located in front of the anterior rectal wall. We decided to perform a combined procedure of transanal rectal resection with a simultaneous laparoscopy for patients with obstructed defecation syndrome and an enterocele.
Between November 2002 and May 2005 a total of 41 patients were treated surgically for obstructed defecation syndrome. Four patients with concomitant enterocele underwent stapled transanal rectal resection under laparoscopic surveillance. Before surgery all patients underwent preoperative assessment, including clinical examination, colonoscopy, conventional video defecography, dynamic magnetic resonance imaging defecography, gynecology examinations, and psychologic evaluation.
The mean operative time was 50 (+/-16.5) minutes for the conventional stapled transanal rectal resection and 67 (+/-14.1) minutes for combined laparoscopy and stapled transanal rectal resection (P < 0.01). Three major complications were observed: two had bleeding in the staple line (one from each group) and one had a late abscess in the staple line.
The combination of the stapled transanal rectal resection procedure and laparoscopy provides the opportunity to perform transanal rectal resection without the threat of intra-abdominal lesions caused by enterocele.
吻合器经肛门直肠切除术最近成为治疗排便梗阻综合征的推荐手术方法。在直肠手术中使用经肛门吻合器时的一个问题是对直肠前壁前方结构的潜在威胁。我们决定对患有排便梗阻综合征和肠膨出的患者进行经肛门直肠切除联合腹腔镜手术。
2002年11月至2005年5月期间，共有41例患者接受了排便梗阻综合征的手术治疗。4例合并肠膨出的患者在腹腔镜监测下接受了吻合器经肛门直肠切除术。术前所有患者均接受了术前评估，包括临床检查、结肠镜检查、传统排粪造影、动态磁共振成像排粪造影、妇科检查和心理评估。
传统吻合器经肛门直肠切除术的平均手术时间为50（±16.5）分钟，腹腔镜联合吻合器经肛门直肠切除术的平均手术时间为67（±14.1）分钟（P<0.01）。观察到3例主要并发症：2例吻合口出血（每组1例），1例吻合口晚期脓肿。
吻合器经肛门直肠切除术与腹腔镜手术相结合，为进行经肛门直肠切除术提供了机会，且不会受到肠膨出引起的腹腔内病变的威胁。
