Tsunoda Akira, Ohta Tomoyuki, Kiyasu Yoshiyuki, Kusanagi Hiroshi
Department of Surgery, Kameda Medical Center, Chiba, Japan.
Dis Colon Rectum. 2015 Apr;58(4):449-56. doi: 10.1097/DCR.0000000000000328.
Laparoscopic ventral rectopexy can relieve symptoms of obstructed defecation and fecal incontinence in patients with rectoanal intussusception. However, pelvic floor imaging after surgery has not been reported.
This study was designed to assess the outcome of patients who underwent laparoscopic ventral rectopexy for rectoanal intussusception, with special reference to the postoperative findings on evacuation proctography.
This study was a retrospective analysis of prospectively collected data.
The study was conducted from 2012 to 2013 at the Department of Surgery, Kameda Medical Center, Japan.
We included 26 patients with symptomatic rectoanal intussusception.
Laparoscopic ventral rectopexy was performed.
Evacuation proctography was performed before and 6 months after the procedure. Defecatory function was evaluated using the Constipation Scoring System and Fecal Incontinence Severity Index.
Of 26 patients with rectoanal intussusception preoperatively, 22 had symptoms of obstructed defecation and 21 complained of fecal incontinence. Postoperatively, rectoanal intussusception was eliminated in all patients, though 8 developed recto rectal intussusception. There was an overall reduction in both grade 2 rectocele size (median preop 26 mm vs. postop 11 mm; p < 0.0001) and pelvic floor descent (median preop 26 mm vs. postop 20 mm; p < 0.0001). 6 months after surgery, a reduction of at least 50% was observed in the Constipation Scoring System score for 9 patients (41%) with obstructive defecation and in the Fecal Incontinence Severity Index score for 14 incontinent patients (67%).
This was a preliminary study with a small sample size, no control group, and short follow-up time.
Evacuation proctography showed anatomical correction in patients with rectoanal intussusception who underwent laparoscopic ventral rectopexy. However, the data also indicate that such correction does not necessarily result in meaningful symptomatic relief.
腹腔镜下腹直肌固定术可缓解直肠套叠患者的排便梗阻和大便失禁症状。然而，术后盆底成像尚未见报道。
本研究旨在评估接受腹腔镜下腹直肌固定术治疗直肠套叠患者的治疗效果，特别关注排粪造影的术后结果。
本研究是对前瞻性收集数据的回顾性分析。
该研究于2012年至2013年在日本龟田医疗中心外科进行。
我们纳入了26例有症状的直肠套叠患者。
实施腹腔镜下腹直肌固定术。
在手术前和术后6个月进行排粪造影。使用便秘评分系统和大便失禁严重程度指数评估排便功能。
26例术前直肠套叠患者中，22例有排便梗阻症状，21例主诉大便失禁。术后，所有患者的直肠套叠均得以消除，尽管有8例出现直肠直肠套叠。2级直肠膨出大小总体减小（术前中位数26mm，术后11mm；p<0.0001），盆底下降也减小（术前中位数26mm，术后20mm；p<0.0001）。术后6个月，9例（41%）有排便梗阻的患者便秘评分系统得分至少降低50%，14例大便失禁患者（67%）的大便失禁严重程度指数得分降低。
这是一项样本量小、无对照组且随访时间短的初步研究。
排粪造影显示接受腹腔镜下腹直肌固定术的直肠套叠患者在解剖结构上得到矫正。然而，数据也表明这种矫正不一定能带来有意义的症状缓解。
