Titov A Iu, Biriukov O M, Fomenko O Iu, Zarodniuk I V, Voĭnov M A
A.N. Ryzhikh State Research Coloproctology Center, Russian Ministry of Health, Moscow.
Khirurgiia (Mosk). 2016(1):33-37. doi: 10.17116/hirurgia2016133-37.
To compare results of rectosacropexy and posterior-loop rectopexy in rectal prolapse management.
Study included 122 patients operated for rectal prolapse for the period January 2007 to August 2014. Patients' age ranged from 19 to 85 years (mean 47.3±16.1). Main group consisted of 60 (49.2%) patients who underwent rectosacropexy (D'Hoore's procedure). Control group included 62 (50.8%) patients in whom posterior-loop rectopexy was applied (Wells's procedure).
Long-term results were followed-up in 94 (77.0%) patients including 48 and 46 from main and control group respectively. Recurrent prolaple incidence after rectosacropexy and posterior-loop rectopexy was 2% and 8.7% respectively. Multivariant analysis statistically confirmed that postoperative impaired colon motility was independent risk factor of recurrence. Recurrent disease is observed 5.7 times more often in this case. Rectosacropexy does not significantly impair colon motility because of ileus occurs in 8.3% of operated patients. Impovement of anal continence does not depend on rectopexy method and occurs in all patients with degree 1-2 of anal sphincter failure.
Rectosacropexy may be preferred in rectal prolapse. However, further highly significant studies are necessary to optimize rectal prolapse management.
比较直肠固定术和后环直肠固定术治疗直肠脱垂的效果。
研究纳入了2007年1月至2014年8月期间因直肠脱垂接受手术的122例患者。患者年龄在19岁至85岁之间（平均47.3±16.1岁）。主要组由60例（49.2%）接受直肠固定术（德胡尔手术）的患者组成。对照组包括62例（50.8%）接受后环直肠固定术（韦尔斯手术）的患者。
对94例（77.0%）患者进行了长期随访，其中主要组和对照组分别为48例和46例。直肠固定术和后环直肠固定术后的复发脱垂发生率分别为2%和8.7%。多变量分析在统计学上证实，术后结肠动力受损是复发的独立危险因素。在这种情况下，复发性疾病的发生率高出5.7倍。直肠固定术不会显著损害结肠动力，因为8.3%的手术患者发生肠梗阻。肛门节制功能的改善不取决于直肠固定术的方法，所有肛门括约肌功能1 - 2级的患者均有改善。
直肠脱垂时直肠固定术可能更可取。然而，需要进一步开展具有高度显著性的研究以优化直肠脱垂的治疗。
