Reichert M, Busse A, Hecker A, Askevold I, Kampschulte M, Wüsten O, Krombach G A, Schwandner T, Padberg W
Department of General and Thoracic Surgery, University Hospital of Giessen, Germany.
Department of Diagnostic and Interventional Radiology, University Hospital of Giessen, Germany.
Rofo. 2016 Jan;188(1):38-44. doi: 10.1055/s-0041-105406. Epub 2015 Sep 1.
Resection rectopexy (RR) provides good functional results and low recurrence rates for the treatment of obstructed defecation syndrome based on rectal prolapse and cul-de-sac syndrome, whereas little is known about changes in pelvic floor dynamics and patient satisfaction after surgery.
Within three years 26 consecutive female patients were prospectively included. Indications for RR (22 laparoscopic, 3 primary open and 1 converted-to-open) were rectal prolapse III° in 11 patients and cul-de-sac syndrome in 15 patients. Patients' quality of life (QOL), fecal behavior and defecation-associated pain were investigated before and after surgical treatment using anamnesis and clinical examination, Rand 36-idem health survey (SF-36), Cleveland-Clinic Incontinence Score (CCIS) and the visual analog scale for defecation-associated pain (VAS). Dynamic pelvic floor magnet resonance imaging (dPF-MRI) was used for the investigation of changes in pelvic floor anatomy and function before and after surgery.
RR improved the rate of fecal incontinence (p < 0.01) and CCIS (p = 0.01). The use of laxatives (p = 0.01), the need for self-digitation (p = 0.02) and VAS (p < 0.01) were decreased, leading to improvements in QOL (overall p < 0.01). RR led to shortening of the H-line but not of the M-line under rest (p < 0.01) and during defecation (p = 0.04). A rectocele was co-incident in all patients in dPF-MRI before surgery. RR led to a reduction (p < 0.01) and declined protrusion (p = 0.03) of the rectocele. This results in a decreased rate of cul-de-sac (p < 0.01) and increased rate of complete defecation (p < 0.01) after surgery. At the 36-month follow-up no recurrence was observed.
RR promises high rates of patient satisfaction and improvement in pelvic floor anatomy in select patients.
• RR improves the pelvic floor anatomy of patients suffering from ODS. • RR improves the QOL of patients suffering from ODS. • An improvement in pelvic floor anatomy led to an improved QOL. • RR is an adequate treatment for select patients suffering from ODS.
对于基于直肠脱垂和直肠陷凹综合征的排便梗阻综合征的治疗，直肠切除直肠固定术（RR）能产生良好的功能效果且复发率低，然而对于术后盆底动力学变化及患者满意度却知之甚少。
三年内前瞻性纳入26例连续的女性患者。RR的适应证（22例腹腔镜手术、3例初次开放手术和1例转为开放手术）为11例Ⅲ度直肠脱垂患者和15例直肠陷凹综合征患者。采用病史采集和临床检查、兰德36项健康调查（SF - 36）、克利夫兰诊所失禁评分（CCIS）以及排便相关疼痛视觉模拟量表（VAS），在手术治疗前后对患者的生活质量（QOL）、排便行为和排便相关疼痛进行调查。采用动态盆底磁共振成像（dPF - MRI）研究手术前后盆底解剖结构和功能的变化。
RR改善了大便失禁发生率（p<0.01）和CCIS（p = 0.01）。缓泻剂的使用（p = 0.01）、自行手指辅助排便的需求（p = 0.02）以及VAS（p<0.01）均降低，导致QOL得到改善（总体p<0.01）。RR导致静息状态下（p<0.01）和排便时（p = 0.04）H线缩短，但M线未缩短。术前所有患者在dPF - MRI检查中均合并直肠膨出。RR导致直肠膨出缩小（p<0.01）和突出程度降低（p = 0.03）。这使得术后直肠陷凹发生率降低（p<0.01），完全排便率提高（p<0.01）。在36个月的随访中未观察到复发。
RR有望使特定患者获得较高的满意度并改善盆底解剖结构。
•RR改善了排便梗阻综合征患者的盆底解剖结构。•RR改善了排便梗阻综合征患者的生活质量。•盆底解剖结构的改善导致生活质量提高。•RR是特定排便梗阻综合征患者的一种适当治疗方法。
