Puigdollers A, Fernández-Fraga X, Azpiroz F
Proctology Unit, Hospital of Mollet, Barcelona, Spain.
Colorectal Dis. 2007 Mar;9(3):262-5. doi: 10.1111/j.1463-1318.2006.01155.x.
Rectocele is frequently associated with constipation, but it is not known whether a causal relationship exists.
To determine the effect of rectocele repair on symptoms of constipation.
Thirty-five women (28-79 years) consecutively operated for rectocele repair (11 transanal approach and 24 transperineal) were included in the prospective study. Using a structured questionnaire, the following criteria for constipation were evaluated: (a) straining, (b) sensation of anal blockage, (c) sensation of incomplete evacuation, (d) manual manoeuvres to facilitate defecation, (e) stool consistency and (f) stool frequency. The evaluation was performed before and 1 year after rectocele repair.
Before the operation all patients had two or more constipation criteria, including sensation of anal blockage. One year after the operation, the incidence of all symptoms significantly improved (from 3.9 +/- 0.2 to 1.9 +/- 0.3; P < 0.01). However, in 18 patients two or more criteria of constipation persisted, two patients presented one criterion, and only 15 patients became asymptomatic. Neither parity nor the type of surgical approach (endorectal vs transperineal) was related to the response to treatment. In eight patients who had a previous hysterectomy the result was significantly worse.
In a considerable proportion of patients, constipation persists after rectocele repair, suggesting that these symptoms are related to an underlying dysfunction.
直肠膨出常与便秘相关，但因果关系尚不明确。
确定直肠膨出修复术对便秘症状的影响。
35名年龄在28至79岁之间、连续接受直肠膨出修复手术（11例经肛门入路，24例经会阴入路）的女性纳入该前瞻性研究。使用结构化问卷对以下便秘标准进行评估：（a）用力排便，（b）肛门阻塞感，（c）排便不尽感，（d）借助手法辅助排便，（e）大便性状，（f）排便频率。评估在直肠膨出修复术前及术后1年进行。
术前所有患者均有两项或更多便秘标准，包括肛门阻塞感。术后1年，所有症状的发生率均显著改善（从3.9±0.2降至1.9±0.3；P<0.01）。然而，18例患者仍有两项或更多便秘标准，2例患者有一项标准，只有15例患者无症状。产次和手术入路类型（直肠内入路与经会阴入路）均与治疗反应无关。8例曾行子宫切除术的患者结果明显较差。
相当一部分患者在直肠膨出修复术后便秘仍然存在，提示这些症状与潜在的功能障碍有关。
