Colorectal Eporediensis Centre, Gruppo Policlinico di Monza, Divisione di Chirurgia Colorettale, Clinica Santa Rita, Vercelli, Italy.
Colorectal Dis. 2013 Mar;15(3):e144-50. doi: 10.1111/codi.12092.
The outcome of the internal Delorme's procedure (IDP) for obstructed defaecation was assessed.
From October 2001 to March 2009, 167 patients with obstructed defaecation associated with rectal intussusception were operated on. Patients were selected on the basis of validated constipation and continence scores, clinical examination and defaecography. Seventy-six patients were treated by the IDP alone and 91 patients were treated by the IDP with a levatorplasty. Before surgery and after a mean ± SD follow up of 3.0 ± 1.5 years, patients were assessed using the Cleveland Clinic Incontinence and Constipation Score (CCIS and CCCS), the Obstructed Defecation Score (ODS), faecal urgency and the Patient Assessment of Constipation Quality of Life (PAC-QoL) questionnaire.
Seventeen (10.2%) patients developed a postoperative complication including fissure-in-ano (4.2%), proctalgia (3.0%), suture-line dehiscence with stenosis (1.8%) and Clostridium difficile colitis (1.2%). Faecal urgency changed from 22% to 17.6% (P = 0.754). Tenesmus fell from 53.9% to 17.1% (P < 0.001). The CCCS and the ODS fell by 50% or more in 82.6% and 73.7% of the patients, respectively. The CCIS did not worsen significantly in patients who remained incontinent, and 45.7% of the previously incontinent patients regained normal continence. The CCCS decreased from 11 to 3 (P < 0.001) in the patients treated by the IDP and from 12 to 3 (P < 0.001) in the patients treated by the IDP with levatorplasty. The overall recurrence rate was 5.4%. The PAC-QoL showed a reduction of anxiety/depression and of physical and psychological discomfort (P < 0.001).
The IDP is an effective and safe option for rectal outlet obstruction caused by rectal intussusception with excellent function and patient satisfaction.
评估经肛门内 Delorme 手术（IDP）治疗出口梗阻性便秘的效果。
2001 年 10 月至 2009 年 3 月，对 167 例合并直肠套叠的出口梗阻性便秘患者进行了手术治疗。这些患者是根据经过验证的便秘和控便评分、临床检查和排粪造影结果选择的。76 例患者单独接受 IDP 治疗，91 例患者接受 IDP 联合提肛肌成形术治疗。在手术前和平均 3.0±1.5 年的随访后，使用克利夫兰便秘和控便评分（CCIS 和 CCCS）、梗阻性排便评分（ODS）、粪便急迫感和患者便秘生活质量问卷（PAC-QoL）评估患者的情况。
17 例（10.2%）患者出现术后并发症，包括肛裂（4.2%）、直肠痛（3.0%）、缝线裂开伴狭窄（1.8%）和艰难梭菌结肠炎（1.2%）。粪便急迫感从 22%降至 17.6%（P=0.754）。里急后重从 53.9%降至 17.1%（P<0.001）。82.6%和 73.7%的患者 CCCS 和 ODS 分别下降 50%或更多。对仍有失禁的患者，CCIS 无明显恶化，45.7%的既往失禁患者恢复正常控便。接受 IDP 治疗的患者 CCCS 从 11 降至 3（P<0.001），接受 IDP 联合提肛肌成形术治疗的患者 CCCS 从 12 降至 3（P<0.001）。总的复发率为 5.4%。PAC-QoL 显示焦虑/抑郁和身体及心理不适减轻（P<0.001）。
IDP 是一种有效且安全的治疗直肠套叠所致直肠出口梗阻的方法，其功能和患者满意度均良好。
