1School of Medicine, Federal University of Ceara and Hospital Sao Carlos, Fortaleza, Brazil 2Clinical Hospital, University of Chile, Santiago, Chile 3Santa Casa de Porto Alegre, Rio Grande do Sul, Brazil.
Dis Colon Rectum. 2014 Nov;57(11):1324-8. doi: 10.1097/DCR.0000000000000229.
The aim of the current study was to demonstrate the use of a modified stapling technique, called the apex technique, to treat rectal intussusception and full rectal mucosal prolapse. It was conducted as a retrospective study at 3 centers (2 in Brazil and 1 in Chile).
The apex technique is performed by using a HEM/EEA-33 stapler. A pursestring suture is placed at the apex of the prolapse, on the 4 quadrants, independent of the distance to the dentate line. A second pursestring is then placed to define the band of rectal mucosa to be symmetrically resected.
Outcome measures included width of the resected full-thickness rectal wall; the intensity of postoperative pain on a visual analog scale from 1 to 10; full mucosal prolapse and rectal intussusception assessed by physical examination, cinedefecography, or echodefecography; and change in the constipation scale.
Forty-five patients (30 women/15 men; mean age, 59.5 years) with rectal intussusception and full mucosal prolapse were included. The median operative time was 17 (range, 15-30) minutes. Bleeding after stapler fire requiring manual suture occurred in 3 patients (6.7%); 25 (55.6%) patients reported having no postoperative pain. Hospital stay was 24 hours. The mean width of the resected rectal wall was 5.9 (range, 5.0-7.5) cm. Stricture at the staple line was seen in 4 patients, of whom 1 required dilation under anesthesia. The median follow-up time was 120 (range, 90-120) days. A small residual prolapse was identified in 6 (13.3%) patients. Imaging demonstrated complete disappearance of rectal intussusception in all patients, and the mean postoperative constipation score decreased from 13 (range, 8-15) to 5 (range, 3-7).
The apex technique appears to be a safe, quickly performed, and low-cost method for the treatment of rectal intussusception. In this series, imaging examinations showed the disappearance of rectal intussusception, and a significant decrease in constipation score suggested improvement in functional outcomes.
本研究旨在展示一种改良的吻合技术，即顶点技术，用于治疗直肠套叠和完全直肠黏膜脱垂。这是在 3 个中心（2 个在巴西，1 个在智利）进行的回顾性研究。
顶点技术是使用 HEM/EEA-33 吻合器进行的。在脱垂的顶点，即 4 个象限，放置荷包缝线，与齿状线的距离无关。然后放置第二条荷包缝线，以确定要对称切除的直肠黏膜带。
包括切除的全层直肠壁的宽度；术后疼痛视觉模拟评分（VAS）从 1 到 10 的强度；通过体格检查、排粪造影或超声排粪造影评估的完全黏膜脱垂和直肠套叠；便秘评分的变化。
共纳入 45 例直肠套叠和完全黏膜脱垂患者（30 例女性/15 例男性；平均年龄 59.5 岁）。中位手术时间为 17 分钟（范围，15-30 分钟）。吻合器点火后出血需要手动缝合的患者有 3 例（6.7%）；25 例（55.6%）患者报告术后无疼痛。住院时间为 24 小时。切除的直肠壁平均宽度为 5.9cm（范围，5.0-7.5cm）。吻合口狭窄 4 例，其中 1 例需要在麻醉下扩张。中位随访时间为 120 天（范围，90-120 天）。6 例（13.3%）患者发现有小的残留脱垂。所有患者的影像学检查均显示直肠套叠完全消失，术后便秘评分从 13（范围，8-15）降至 5（范围，3-7）。
顶点技术似乎是一种安全、快速且低成本的治疗直肠套叠的方法。在本系列中，影像学检查显示直肠套叠消失，便秘评分显著下降，提示功能结局改善。
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