Department of Colorectal Surgery, John Radcliffe and Churchill Hospital, Oxford, OX3 9DU, UK.
Department of Visceral Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland.
Tech Coloproctol. 2017 Aug;21(8):627-632. doi: 10.1007/s10151-017-1643-7. Epub 2017 Jul 3.
Laparoscopic ventral mesh rectopexy (LVMR) has become a well-established treatment for symptomatic high-grade internal rectal prolapse. The aim of this study was to identify proctographic criteria predictive of a successful outcome.
One hundred and twenty consecutive patients were evaluated from a prospectively maintained pelvic floor database. Pre- and post-operative functional results were assessed with the Wexner constipation score (WCS) and Fecal Incontinence Severity Index (FISI). Proctogram criteria were analyzed against functional results. These included grade of intussusception, presence of enterocele, rectocele, excessive perineal descent and the orientation of the rectal axis at rest (vertical vs. horizontal).
Ninety-one patients completed both pre- and post-operative follow-up questionnaires. Median pre-operative WCS was 14 (range 10-17), and median FISI was 20 (range 0-61), with 28 patients (31%) having a FISI above 30. The presence of an enterocele was associated with more frequent complete resolution of obstructed defecation (70 vs. 52%, p = 0.02) and fecal incontinence symptoms (71 vs. 38%, p = 0.01) after LVMR. Patients with a more horizontal rectum at rest pre-operatively had significantly less resolution of symptoms post-operatively (p = 0.03).
These data show that proctographic findings can help predict functional outcomes after LVMR. Presence of an enterocele and a vertical axis of the rectum at rest may be associated with a better resolution of symptoms.
腹腔镜下腹膜直肠前突固定术（LVMR）已成为治疗有症状的高位直肠内脱垂的成熟方法。本研究旨在确定能预测手术成功的直肠测压标准。
我们从一个前瞻性维护的盆底数据库中评估了 120 例连续患者。使用 Wexner 便秘评分（WCS）和粪便失禁严重程度指数（FISI）评估术前和术后的功能结果。根据功能结果分析直肠测压标准，包括内套叠程度、是否存在肠疝、直肠前突、会阴过度下降以及直肠轴在休息时的方向（垂直与水平）。
91 例患者完成了术前和术后的随访问卷。术前中位 WCS 为 14 分（范围 10-17），中位 FISI 为 20 分（范围 0-61），28 例（31%）患者的 FISI 超过 30。肠疝的存在与阻塞性排便困难（70%比 52%，p=0.02）和粪便失禁症状（71%比 38%，p=0.01）更频繁完全缓解相关。术前直肠在休息时更水平的患者术后症状缓解明显减少（p=0.03）。
这些数据表明，直肠测压结果可以帮助预测 LVMR 后的功能结果。肠疝的存在和直肠在休息时的垂直轴可能与症状的更好缓解相关。
