Sayfan J, Pinho M, Alexander-Williams J, Keighley M R
Department of Surgery, General Hospital, Birmingham, UK.
Br J Surg. 1990 Feb;77(2):143-5. doi: 10.1002/bjs.1800770209.
Two treatment policies for rectal prolapse were prospectively assessed between April 1986 and January 1989. Sixteen patients had a Marlex mesh posterior rectopexy alone and 13 underwent a sigmoidectomy combined with a sutured posterior rectopexy. Preoperative and post-operative assessment included manometry, a saline infusion test and video-proctography. Hospital stay, control of prolapse and complications were comparable in both groups. Restoration of continence occurred in nine of the 12 incontinent patients after Marlex rectopexy, compared with six of nine after sutured rectopexy and sigmoidectomy. Constipation persisted in three patients who were constipated before operation and in four of 13 who had previously normal bowel habits became constipated after Marlex rectopexy; constipation persisted in one of five previously constipated patients while none with previously normal bowel habits became constipated after sutured rectopexy and sigmoidectomy. Sigmoidectomy combined with sutured rectopexy was safe and as efficient as Marlex rectopexy in prolapse control and improvement of continence; significantly fewer patients were constipated (one of 13) after sigmoidectomy than following rectopexy alone (seven of 16). A randomized trial now seems justified.
1986年4月至1989年1月期间，对直肠脱垂的两种治疗策略进行了前瞻性评估。16例患者仅接受了Marlex网片后路直肠固定术，13例患者接受了乙状结肠切除术联合缝合后路直肠固定术。术前和术后评估包括测压、盐水灌注试验和视频直肠造影。两组患者的住院时间、脱垂控制情况和并发症情况相当。Marlex直肠固定术后，12例失禁患者中有9例恢复了控便能力，而缝合直肠固定术联合乙状结肠切除术后，9例中有6例恢复了控便能力。术前便秘的3例患者术后便秘仍持续存在，13例术前排便习惯正常的患者中，4例在接受Marlex直肠固定术后出现便秘；5例术前便秘的患者中，1例术后便秘仍持续存在，而缝合直肠固定术联合乙状结肠切除术后，术前排便习惯正常的患者无一例出现便秘。乙状结肠切除术联合缝合直肠固定术在控制脱垂和改善控便能力方面与Marlex直肠固定术一样安全有效；乙状结肠切除术后便秘的患者明显少于单纯直肠固定术（13例中的1例对比16例中的7例）。现在看来进行一项随机试验是合理的。
