Pelvic Floor Service, Department of Colorectal Surgery, John Radcliffe Hospital, Oxford, UK.
Colorectal Dis. 2010 Jun;12(6):526-32. doi: 10.1111/j.1463-1318.2009.01859.x. Epub 2009 Apr 10.
Abdominal rectopexy is ideal for otherwise healthy patients with rectal prolapse because of low recurrence, yet after posterior rectopexy, half of the patients complain of severe constipation. Resection mitigates this dysfunction but risks a pelvic anastomosis. The novel nerve-sparing ventral rectopexy appears to avoid postero-lateral rectal dissection denervation and thus postoperative constipation. We aimed to evaluate our functional results with laparoscopic ventral rectopexy.
Consecutive rectal prolapse patients undergoing laparoscopic ventral rectopexy were prospectively assessed (Wexner Constipation and Faecal Incontinence Severity Index scores) pre-, 3 months postoperatively, and late (> 12 months).
Sixty-five consecutive patients with external rectal prolapse (median age 72 years, 34% > 80 years, median follow up 19 months) underwent laparoscopic ventral rectopexy. There was one recurrence (2%) and one conversion. Morbidity (17%) and mortality (0%) were low. Median operating time was 140 min and median length of stay 2 days. At 3 months, constipation was improved in 72% and mildly induced in 2% (median pre-and postoperative Wexner scores 9 vs 4, P < 0.0001). Continence was improved in 83% and mild incontinence was induced or worsened in 5% (median pre- and postoperative incontinence score 40 vs 4, P < 0.0001). Significant improvement in both constipation and incontinence (P < 0.0001) remained at median 24 months late follow-up.
Ventral rectopexy has a recurrent prolapse rate of < 5%, similar to that of posterior rectopexy. Its correction of preoperative constipation and avoidance of de novo constipation appear superior to historical functional results of posterior rectopexy. A laparoscopic approach allows low morbidity and short hospital stay, even in those patients over 80 years of age in whom a perineal approach is usually preferred for safety.
对于因复发率低而适合行腹会阴直肠切除术的健康直肠脱垂患者，后方直肠固定术是理想的选择，但后方直肠固定术后，一半的患者会出现严重的便秘。直肠切除可减轻这种功能障碍，但存在吻合口漏的风险。新型的保留神经的腹侧直肠固定术似乎可以避免后侧直肠分离后的去神经，从而避免术后便秘。我们旨在评估腹腔镜腹侧直肠固定术的功能结果。
对连续接受腹腔镜腹侧直肠固定术的直肠脱垂患者进行前瞻性评估（Wexner 便秘和粪便失禁严重程度指数评分），分别在术前、术后 3 个月和术后>12 个月时进行评估。
65 例患有外部直肠脱垂的连续患者（中位年龄 72 岁，34%>80 岁，中位随访时间为 19 个月）接受了腹腔镜腹侧直肠固定术。有 1 例复发（2%）和 1 例中转开腹。发病率（17%）和死亡率（0%）均较低。中位手术时间为 140 分钟，中位住院时间为 2 天。术后 3 个月时，72%的患者便秘得到改善，2%的患者轻度便秘（中位术前和术后 Wexner 评分分别为 9 分和 4 分，P<0.0001）。83%的患者控便能力得到改善，5%的患者出现轻度失禁或加重（中位术前和术后失禁评分分别为 40 分和 4 分，P<0.0001）。在中位 24 个月的随访中，便秘和失禁均显著改善（P<0.0001）。
腹侧直肠固定术的复发率<5%，与后方直肠固定术相似。其对术前便秘的纠正和避免新发便秘的效果似乎优于后方直肠固定术的历史功能结果。腹腔镜方法可降低发病率和缩短住院时间，即使是 80 岁以上的患者，通常也会选择经会阴入路以确保安全。
