von Papen Michael, Ashari Luai H S, Lumley John W, Stevenson Andrew R L, Stitz Russell W
Department of Surgery, Colorectal Unit, Royal Brisbane and Women's Hospital, Brisbane, Australia.
Dis Colon Rectum. 2007 Jan;50(1):50-5. doi: 10.1007/s10350-006-0781-1.
This study was designed to assess the role of laparoscopic resection rectopexy for symptomatic rectal intussusception in patients who failed medical treatment. The functional outcomes of laparoscopic resection rectopexy were evaluated.
Patients who underwent laparoscopic resection rectopexy for rectal intussusception between July 1998 and November 2004 were identified. All patients with obstructed defecation failing medical treatment were included. Data were prospectively collected for the perioperative period. A follow-up questionnaire was used to assess functional outcome.
Between 1998 and 2004, a total of 56 patients (53 females (95 percent); age range, 23-83 years) underwent laparoscopic resection rectopexy for rectal intussusception. The median operative time was 123 minutes. Morbidity was 7 percent, and there was no mortality. Fifty-two patients were available for follow-up, and of these 33 (63 percent) reported an overall improvement in their function after surgery. Of 28 patients suffering constipation, 15 (53 percent) reported an improvement in bowel frequency. Sixty-seven percent of patients incontinent before surgery improved. Symptoms of incomplete evacuation resolved in 38 percent of affected patients. Thirty-six percent of patients needing to strain at stool did not have this problem after surgery. Median follow-up was 44 (range, 15-92) months.
The management of patients with rectal intussusception and obstructed defecation failing medical treatment is challenging. Laparoscopic resection rectopexy is an option that might offer symptomatic relief and improved function. Further studies are required to define the selection criteria to optimize the outcome in this patient group.
本研究旨在评估腹腔镜切除直肠固定术对经药物治疗无效的有症状直肠套叠患者的作用。对腹腔镜切除直肠固定术的功能结局进行评估。
确定1998年7月至2004年11月间接受腹腔镜切除直肠固定术治疗直肠套叠的患者。纳入所有经药物治疗排便梗阻无效的患者。前瞻性收集围手术期数据。采用随访问卷评估功能结局。
1998年至2004年间，共有56例患者（53例女性（95%）；年龄范围23 - 83岁）接受了腹腔镜切除直肠固定术治疗直肠套叠。中位手术时间为123分钟。发病率为7%，无死亡病例。52例患者可供随访，其中33例（63%）报告术后功能总体改善。在28例便秘患者中，15例（53%）报告排便频率改善。术前失禁的患者中有67%症状改善。38%的受累患者不完全排空症状得到缓解。36%术前排便时需要用力的患者术后不再有此问题。中位随访时间为44（范围15 - 92）个月。
对经药物治疗无效的直肠套叠和排便梗阻患者的管理具有挑战性。腹腔镜切除直肠固定术是一种可能提供症状缓解和功能改善的选择。需要进一步研究以确定选择标准，优化该患者群体的治疗结局。
