Mistrangelo M, Tonello P, Brachet Contul R, Arnone G, Passera R, Grasso L, Rapetti L, Borroni R, Pozzo M, Roveroni M, Morino M, Perinotti R
Department of Surgical Sciences, Centre of Minimal Invasive Surgery, University of Turin, Turin, Italy.
Department of Surgery, Koelliker Hospital, Turin, Italy.
Colorectal Dis. 2016 Nov;18(11):1094-1100. doi: 10.1111/codi.13328.
Many different surgical techniques have been reported for the surgical treatment of full-thickness external rectal prolapse. Perianal stapled prolapse resection (PSP) is a relatively newly reported technique for full thickness external rectal prolapse. The aim of this prospective multicentre study was to evaluate the results of this procedure.
Consecutive patients who underwent a PSP resection for full-thickness external rectal prolapse at five centres were recruited to the study. Median operating time, hospital stay, complications, recurrence and functional results according to the Wexner Incontinence Scale and obstructive defaecation syndrome score were recorded.
There were 27 patients treated by PSP. The median Wexner incontinence score improved from 10 presurgery to 5 after surgery (P < 0.001); the median obstructed defaecation syndrome score improved from 12 presurgery to 5 (range 4-10) after surgery (P < 0.001). A laparoscopically assisted procedure was performed in three patients (11.1%). The median number of cartridges used was six (range four to nine). The median operating time was 48 min. Early complications occurred in six patients (22.2%) and late complications in two (7.4%). The median length of hospital stay was 5 days. The recurrence rate at a median follow-up of 30.3 months was 14.8%.
PSP appears to be an easy, fast and safe procedure. Early functional results are good. The recurrence rate compares favourably with other perineal procedures like the Delorme or the Altemeier operations. Long-term functional results need to be investigated further.
已有多种不同的外科技术用于治疗全层直肠外脱垂。经肛门吻合器直肠脱垂切除术（PSP）是一种相对较新报道的治疗全层直肠外脱垂的技术。这项前瞻性多中心研究的目的是评估该手术的效果。
招募了在五个中心接受PSP切除治疗全层直肠外脱垂的连续患者。记录中位手术时间、住院时间、并发症、复发情况以及根据韦克斯纳失禁量表和排便梗阻综合征评分得出的功能结果。
27例患者接受了PSP治疗。韦克斯纳失禁评分中位数从术前的10分改善至术后的5分（P < 0.001）；排便梗阻综合征评分中位数从术前的12分改善至术后的5分（范围4 - 10分）（P < 0.001）。3例患者（11.1%）接受了腹腔镜辅助手术。使用吻合器的中位数为6个（范围4 - 9个）。中位手术时间为48分钟。6例患者（22.2%）发生早期并发症，2例（7.4%）发生晚期并发症。中位住院时间为5天。中位随访30.3个月时的复发率为14.8%。
PSP似乎是一种简便、快速且安全的手术。早期功能结果良好。与其他会阴手术如德洛姆手术或阿尔特迈尔手术相比，复发率更优。长期功能结果有待进一步研究。
