症状性直肠前突：修复的适应证有哪些？
Symptomatic rectocele: what are the indications for repair?
机构信息
Department of Surgery, Division of Colorectal Surgery, University Hospitals Case Medical Center, Case Western Reserve Medical School, 11100 Euclid Avenue, Cleveland, OH, USA.
Department of Surgery, Division of Colorectal Surgery, University Hospitals Case Medical Center, Case Western Reserve Medical School, 11100 Euclid Avenue, Cleveland, OH, USA.
出版信息
Am J Surg. 2014 Mar;207(3):375-9; discussion 378-9. doi: 10.1016/j.amjsurg.2013.12.002. Epub 2013 Dec 30.
BACKGROUND
The surgical indications for symptomatic rectocele are undefined, and surgery has high recurrence rates. We implemented magnetic resonance imaging defecography (MRID) to determine if utilizing strict inclusion criteria for rectocele repair improves outcomes.
METHODS
Patients with obstructive defecation syndrome (ODS) who underwent dynamic MRID were evaluated. Indications for surgical repair were defecation requiring manual assistance and the following MRID results: anterior defect >2 cm, incomplete evacuation, and the absence of perineal descent. Primary outcomes were the change in quality of life (QOL) scores and recurrence.
RESULTS
From 2006 to 2013, 143 patients who presented with ODS underwent MRID. Seventeen patients met the criteria for repair. Recurrence was low (5.8%) with a median follow-up of 23 months, QOL scores improved from 57.3 to 76.5 (P = .041).
CONCLUSIONS
A minority of patients (12%) with ODS met the above criteria for rectocele repair. Patients who underwent repair had a significant improvement in QOL and low recurrence rate.
背景
症状性直肠前突的手术适应证尚未明确，且手术复发率较高。我们实施了磁共振排粪造影（MRID）检查，以确定是否利用直肠前突修补术的严格纳入标准可以改善治疗效果。
方法
对患有梗阻性排便障碍（ODS）且接受动态 MRID 检查的患者进行评估。手术修复的适应证为排便时需要手动辅助以及存在以下 MRID 结果：前侧缺损>2cm、不完全排空和会阴下降缺失。主要结局是生活质量（QOL）评分的变化和复发情况。
结果
2006 年至 2013 年，143 例 ODS 患者接受了 MRID 检查。17 例患者符合修复标准。中位随访 23 个月时，复发率较低（5.8%），QOL 评分从 57.3 分提高至 76.5 分（P=0.041）。
结论
少数（12%）患有 ODS 的患者符合上述直肠前突修复标准。接受修复的患者的 QOL 显著改善，复发率较低。
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