Glasgow Sean C, Birnbaum Elisa H, Kodner Ira J, Fleshman James W, Dietz David W
Department of Surgery, Section of Colon and Rectal Surgery, Washington University School of Medicine, St. Louis, MO, USA.
J Gastrointest Surg. 2008 Aug;12(8):1446-51. doi: 10.1007/s11605-008-0531-x. Epub 2008 May 31.
Surgical outcome and quality of life (QOL) following perineal proctectomy for rectal prolapse remain poorly documented.
From 1994 to 2004, patients with full-thickness rectal prolapse were treated exclusively with perineal proctectomy independent of age or comorbidities. Subjective patient assessments and recurrences were determined retrospectively from hospital and clinic records. Consenting patients completed the gastrointestinal quality of life index (GIQLI).
Perineal proctectomy was performed in 103 consecutive patients with a median age of 75 years (range 30-94). Most patients underwent concurrent levatorplasty (anterior 85.8%, posterior 67.9%). Durable results were obtained in all patients; the recurrence rate was 8.5% over a mean follow-up of 36 months. Preoperatively, 75.5% of patients reported fecal incontinence, and 32.1% had obstructed defecation. Incontinence significantly improved post-proctectomy (41.5%, p < 0.001), as did constipation (10.4%, p < 0.001). GIQLI respondents reported satisfaction following proctectomy with 63% scoring within one standard deviation of healthy controls. Patients with recurrent prolapse reported a lower QOL. Risk factors for recurrence included duration of prolapse, need for posterior levatorplasty, and prior anorectal surgery.
Perineal proctectomy provides significant relief from fecal incontinence and obstructive symptoms caused by rectal prolapse, with an acceptable recurrence rate and low morbidity.
直肠脱垂经会阴直肠切除术的手术效果和生活质量（QOL）仍缺乏充分记录。
1994年至2004年，全层直肠脱垂患者均仅接受会阴直肠切除术，不受年龄或合并症影响。通过回顾医院和诊所记录确定患者的主观评估和复发情况。同意参与的患者完成了胃肠道生活质量指数（GIQLI）评估。
连续103例患者接受了会阴直肠切除术，中位年龄为75岁（范围30 - 94岁）。大多数患者同时进行了提肛肌成形术（前路85.8%，后路67.9%）。所有患者均取得了持久效果；平均随访36个月时复发率为8.5%。术前，75.5%的患者报告有大便失禁，32.1%有排便梗阻。直肠切除术后失禁情况显著改善（41.5%，p < 0.001），便秘情况也有所改善（10.4%，p < 0.001）。GIQLI评估的受访者报告直肠切除术后感到满意，63%的得分在健康对照组的一个标准差范围内。复发脱垂患者的生活质量较低。复发的危险因素包括脱垂持续时间、是否需要后路提肛肌成形术以及既往肛肠手术史。
会阴直肠切除术能显著缓解直肠脱垂引起的大便失禁和梗阻症状，复发率可接受且发病率低。
