Johnson Egil, Kjellevold Kristin, Johannessen Hans-Olaf, Drolsum Anders
Department of Gastroenterological and Pediatric Surgery, Oslo University Hospital, Ulleval, Kirkeveien 166, 0407 Oslo, Norway ; Faculty of Medicine, University of Oslo, P.O. Box 1072 Blindern, 0316 Oslo, Norway.
ISRN Gastroenterol. 2012;2012:824671. doi: 10.5402/2012/824671. Epub 2012 Dec 30.
Background and Aims. The optimal treatment of patients with internal rectal intussusception (IRI) is unresolved. The aim was to study the short- and long-term outcome of resection rectopexy in these patients. Methods. An observational and mainly prospective study of 48 patients (44 women) with IRI who had ligament-preserving suture rectopexy by laparoscopic (n = 25) or open (n = 23) technique. Outcome measures were morbidity, scores for constipation and anal incontinence, patients' report, and health-related quality of life (HRQoL). Results. From preoperatively to a median of 6 months and 76 months postoperatively, constipation scores were reduced from a mean of (95% CI) 13.20 (11.41 to 15.00) to 6.91 (5.29 to 8.54) and 6.35 (4.94 to 7.76) (P < 0.0001). The number of constipated patients was reduced from 35 to eleven and eight, respectively, and none became constipated. Nine of ten symptoms of constipation improved. Corresponding scores for anal incontinence were 4.7 (2.4-7.0), 4.0 (2.4-5.7), and 4.1 (2.3-5.8), respectively. HRQoL at long-term followup compared to the general Norwegian population was reduced in four out of eight dimensions concerning physical factors. The patient-reported outcome at short- and long-term followup was improved by 85.4% and 75.0%, respectively. Conclusions. Resection rectopexy for IRI improved the outcome. HRQoL was reduced compared with the general population.
背景与目的。直肠内套叠(IRI)患者的最佳治疗方法尚未确定。本研究旨在探讨这些患者行直肠切除术加直肠固定术的短期和长期疗效。方法。对48例IRI患者(44例女性)进行观察性且主要为前瞻性研究,这些患者通过腹腔镜(n = 25)或开放手术(n = 23)技术行保留韧带的缝合直肠固定术。观察指标包括发病率、便秘和肛门失禁评分、患者报告以及健康相关生活质量(HRQoL)。结果。从术前到术后中位时间6个月和76个月,便秘评分从平均(95%CI)13.20(11.41至15.00)降至6.91(5.29至8.54)和6.35(4.94至7.76)(P < 0.0001)。便秘患者数量分别从35例降至11例和8例,且无新增便秘患者。十种便秘症状中有九种得到改善。肛门失禁的相应评分分别为4.7(2.4 - 7.0)、4.0(2.4 - 5.7)和4.1(2.3 - 5.8)。与挪威普通人群相比,长期随访时HRQoL在八个与身体因素相关的维度中有四个维度降低。患者报告的短期和长期随访结果分别改善了85.4%和75.0%。结论。IRI行直肠切除术加直肠固定术可改善疗效。与普通人群相比,HRQoL有所降低。