Laubert T, Kleemann M, Roblick U J, Bürk C, Schorcht A, Hildebrand P, Bruch H-P
Klinik für Chirurgie, Universitätsklinikum Schleswig-Holstein Campus Lübeck, Lübeck, Deutschland.
Zentralbl Chir. 2012 Aug;137(4):357-63. doi: 10.1055/s-0032-1315125. Epub 2012 Aug 29.
Anorectal outlet obstruction constitutes one form of chronic constipation. Combinations of morphological alterations of the pelvis, the pelvic floor and the colorectum are nearly always evident. The goal of the diagnostic work-up is to identify those patients who will profit from a surgical intervention. Resection rectopexy aims at restoring the physiological anatomy thereby ameliorating the functional interaction of structures effected with the laparoscopic approach entailing all advantages of minimally invasive surgery. Besides a detailed description of the surgical technique used and an algorithm for indications to operate we present our results after 19 years of experience. Throughout this period, 264 laparoscopic resection rectopexies for outlet obstruction were performed. With a mean follow-up of 58.2 months the rate of improvement of obstructive symptoms was 79.5 % (n = 128 of 161 available for follow-up). Present studies suggest that (laparoscopic) resection rectopexy entails better results in comparison to non-resecting procedures and procedures with the implantation of allogenic material. Certainly, in order to achieve these results a correct patient selection and an expertise in laparoscopic surgery are essential. Both the perioperative and the functional results of our own collective fortify the advantages of laparoscopic resection rectopexy in patients with an outlet obstruction.
肛肠出口梗阻是慢性便秘的一种形式。骨盆、盆底和结直肠的形态改变几乎总是同时存在。诊断检查的目的是识别那些能从手术干预中获益的患者。切除性直肠固定术旨在恢复生理解剖结构，从而改善相关结构的功能相互作用，腹腔镜手术方式具有微创手术的所有优点。除了详细描述所使用的手术技术和手术指征算法外，我们还展示了19年经验后的结果。在此期间，共进行了264例腹腔镜切除性直肠固定术治疗出口梗阻。平均随访58.2个月，梗阻症状改善率为79.5%（161例可随访患者中有128例）。目前的研究表明，与非切除手术和植入异体材料的手术相比，（腹腔镜）切除性直肠固定术效果更好。当然，为了取得这些结果，正确的患者选择和腹腔镜手术专业技能至关重要。我们自己团队的围手术期和功能结果都证实了腹腔镜切除性直肠固定术对出口梗阻患者的优势。
