对于直肠前突患者的协同失调性排便困难，手术矫正无效。
Surgical correction is ineffective for improvement of dyssynergic defecation in patients with rectal prolapse.
机构信息
Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
出版信息
J Neurogastroenterol Motil. 2013 Jan;19(1):85-9. doi: 10.5056/jnm.2013.19.1.85. Epub 2013 Jan 8.
BACKGROUND/AIMS: The patients with rectal prolapse suffer from not only a prolapse rectum but also associated dysfunction. However, most surgical techniques are successful regarding the prolapse, but either do not solve or even worsen defecation dysfunction. The purpose of this study was to investigate the functional and physiological results after surgical correction in patients with rectal prolapse.
METHODS
This study is a retrospective review of a single-institution experience. Patients with rectal prolapse who underwent anorectal manometry before and after Delorme's procedure were included. The primary outcomes measured were improvement of clinical symptoms and physiologic study.
RESULTS
Consecutive 19 patients with rectal prolapse (17 females, mean age of 68.1 ± 10.8 years) underwent anorectal manometry before and after Delorme's procedure. The two most prevalent symptoms before operation were rectal tenesmus (15/19, 78.9%) and excessive straining (13/19, 68.4%). The two most prevalent symptoms after operation were rectal tenesmus (14/19, 73.6%) and excessive straining (13/19, 68.4%). No significant differences in resting anal pressure, squeezing anal pressure, defecation index, and rectal sense were found postoperatively. However, vector asymmetry index before surgery was higher than that after surgery (35.0 vs. 32.0, P = 0.018). Ten patients (52.5%) had type I dyssynergic defecation before surgery. No improvement of dyssynergic pattern occurred after surgery.
CONCLUSIONS
In conclusion, dyssynergic defecation was not improved after reduction of rectal prolapse in patients with rectal prolapse. Further study about combination treatment with biofeedback therapy in these subgroups may be necessary.
背景/目的：直肠脱垂患者不仅患有直肠脱垂，还伴有相关功能障碍。然而，大多数手术技术在治疗脱垂方面都取得了成功，但要么没有解决，甚至加重了排便功能障碍。本研究旨在探讨直肠脱垂患者手术后的功能和生理结果。
方法
这是一项单中心回顾性研究。对接受 Delorme 手术前后行肛门直肠测压的直肠脱垂患者进行了研究。主要测量的结果是临床症状和生理研究的改善。
结果
连续 19 例直肠脱垂患者（女性 17 例，平均年龄 68.1±10.8 岁）接受了 Delorme 手术后前后的肛门直肠测压。术前最常见的两个症状是直肠坠胀（15/19，78.9%）和过度用力（13/19，68.4%）。术后最常见的两个症状是直肠坠胀（14/19，73.6%）和过度用力（13/19，68.4%）。术后静息肛门压力、挤压肛门压力、排便指数和直肠感觉无显著差异。然而，术前矢量不对称指数高于术后（35.0 比 32.0，P=0.018）。术前 10 例（52.5%）患者存在 I 型协同性排便障碍。手术后协同模式没有改善。
结论
总之，直肠脱垂患者直肠脱垂复位后协同性排便障碍没有改善。可能需要对这些亚组患者进行生物反馈治疗等联合治疗的进一步研究。
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