Department of Surgery and Cancer, Imperial College London, UK.
Department of Colorectal Surgery, Frenchay Hospital, Bristol & University of Bristol, Bristol, United Kingdom.
Surgery. 2014 Jul;156(1):158-67. doi: 10.1016/j.surg.2014.03.008. Epub 2014 Mar 15.
Laparoscopic ventral mesh rectopexy (LVMR) is a well-recognized treatment for rectal prolapse and high-grade rectal intussusception. However, it is technically complex with the possibility of clinically relevant morbidity. The objectives were to define (i) the efficacy and safety of LVMR, (ii) risk factors for poor clinical outcome, and (iii) the autodidactic proficiency gain curve.
All primary LVMR cases performed by the senior author between January 1997 and February 2013 were included in the study. In addition to the clinical outcomes, quality-of-life outcomes, including the Cleveland Clinic Incontinence Score and obstructive defecation syndrome score, were evaluated. Risk factors for operative complications, recurrence, and mesh-related complications were identified by the use of logistic regression models. Proficiency gain curves for functional and clinical outcomes were assessed using cumulative sum curves.
A total of 636 LVMRs were performed during the study period. The mean percentage improvement in the Cleveland Clinic Incontinence Score and obstructive defecation syndrome score were 89.7% (SD 21.8%) and 56.7% (SD 20.6%). The operative complication, recurrent symptoms, and mesh-related complication rates were 9.9%, 9.4%, and 3.1%, respectively. Predictors of operative complication were male sex and previous abdominal operation; the only predictor of mesh-related complications and recurrence was the use of polyester mesh. The learning curve for operative time was 54 cases, but for other clinical and quality-of-life outcomes was between 82 and 105 cases.
LVMR treats rectal prolapse effectively, providing good symptomatic relief with minimal morbidity. However, the self-taught learning curve for this complex laparoscopic procedure is protracted.
腹腔镜下腹膜前直肠固定术（LVMR）是治疗直肠脱垂和高位直肠套叠的一种公认方法。然而，该手术技术复杂，存在临床相关发病率的可能。目的是定义（i）LVMR 的疗效和安全性，（ii）不良临床结局的风险因素，以及（iii）自学能力提高曲线。
纳入 1997 年 1 月至 2013 年 2 月期间由资深作者进行的所有原发性 LVMR 病例。除临床结果外，还评估了生活质量结果，包括克利夫兰诊所失禁评分和梗阻性排便障碍综合征评分。使用逻辑回归模型确定手术并发症、复发和网片相关并发症的风险因素。使用累积和曲线评估功能和临床结局的熟练度提高曲线。
研究期间共进行了 636 例 LVMR。克利夫兰诊所失禁评分和梗阻性排便障碍综合征评分的平均改善百分比分别为 89.7%（SD 21.8%）和 56.7%（SD 20.6%）。手术并发症、症状复发和网片相关并发症的发生率分别为 9.9%、9.4%和 3.1%。手术并发症的预测因素为男性和既往腹部手术；网片相关并发症和复发的唯一预测因素是使用聚酯网。手术时间的学习曲线为 54 例，但其他临床和生活质量结局的学习曲线在 82 至 105 例之间。
LVMR 有效治疗直肠脱垂，提供良好的症状缓解，且发病率低。然而，这种复杂的腹腔镜手术的自学能力提高曲线较为漫长。
