Department of Colorectal Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, A30, Cleveland, OH, 44195, USA.
World J Surg. 2010 May;34(5):1116-22. doi: 10.1007/s00268-010-0429-0.
We can divide surgery for rectal prolapse into two broad categories: abdominal and perineal. However, few studies compare the long-term outcomes and quality of life among operations for full-thickness rectal prolapse. The purpose of this study was to compare abdominal (AO) versus perineal (PO) procedures for the treatment of full-thickness rectal prolapse regarding recurrence rate, incontinence, constipation, and quality of life.
Records of 177 operations from 1995 to 2001 were reviewed retrospectively. A telephone survey was attempted for all. Seventy-five (42%) responded to the Cleveland Clinic Incontinence Score (CCIS), KESS Constipation Score (KESS-CS), and SF-36 Quality of Life Score. Appropriate statistical analysis was performed.
For the 122 AO and 55 PO, there were no deaths. Mean follow-up was similar (PO 3.1 vs. AO 3.9 years; P = 0.306). As expected the PO patients were older (mean 69 vs. 55 years) and had higher ASA scores. Those undergoing PO had less procedural blood loss, operative time, hospital stay, and dietary restriction. The PO group also scored worse on the physical component of SF-36 (PO 33 vs. AO 39.6; P = 0.034). However, the rate of recurrent prolapse was significantly higher for the PO (PO 26.5% vs. AO 5.2%; P < 0.001). Complications, CCIS, KESS-CS, and SF-36 mental component were similar in both groups.
In full-thickness rectal prolapse, elderly, sick patients are selected for a perineal operation. The morbidity, functional outcomes, and quality of life are acceptable. However, the high recurrence rates make the perineal operation a second-best choice for younger, healthy patients.
我们可以将直肠脱垂手术分为两类：腹部手术和会阴手术。然而，很少有研究比较全层直肠脱垂手术的长期疗效和生活质量。本研究旨在比较全层直肠脱垂的腹部（AO）与会阴（PO）手术，评估复发率、失禁、便秘和生活质量。
回顾性分析 1995 年至 2001 年的 177 例手术记录。对所有患者进行电话调查。共有 75 例（42%）对克利夫兰诊所失禁评分（CCIS）、KESS 便秘评分（KESS-CS）和 SF-36 生活质量评分做出回应。进行了适当的统计分析。
在 122 例 AO 和 55 例 PO 患者中，无死亡病例。平均随访时间相似（PO 3.1 年，AO 3.9 年；P = 0.306）。如预期的那样，PO 患者年龄较大（平均 69 岁，AO 为 55 岁），ASA 评分较高。PO 组术中出血量、手术时间、住院时间和饮食限制较少。PO 组 SF-36 的生理成分评分较差（PO 33 分，AO 39.6 分；P = 0.034）。然而，PO 组的复发率显著较高（PO 26.5%，AO 5.2%；P < 0.001）。两组的并发症、CCIS、KESS-CS 和 SF-36 心理成分评分相似。
在全层直肠脱垂中，老年、体弱患者选择会阴手术。发病率、功能结果和生活质量是可以接受的。然而，高复发率使得会阴手术成为年轻、健康患者的次选。
