Poole G V, Pennell T C, Myers R T, Hightower F
Am Surg. 1985 Apr;51(4):226-9.
Rectal prolapse is best treated by intra-abdominal or perineal procedures that either resect the redundant rectosigmoid colon or fix the rectum within the pelvis. We have found the Thiersch procedure to be adequate treatment in patients who are high risk or who have only mild to moderate prolapse of the rectum. Over the past 20 years, we have treated 15 patients with a modified Thiersch procedure, using a knitted Dacron vascular graft to encircle the anus. One patient required a second Thiersch procedure after failure of a Ripstein procedure that followed failure of a Thiersch procedure done with wire. A second Thiersch procedure was required in two patients after suture breakage, and in one patient after removal of an infected graft. Two other patients had graft infections necessitating removal of the Dacron graft; one patient had a perianal infection that was treated without removing the graft. Continence was achieved in six of nine patients previously incontinent, and maintained in the six patients who had been continent before operation. Prolapse was corrected in 13 of the 15 patients. Although the Thiersch procedure is not applicable to all patients with rectal prolapse, it can be used successfully when performed properly.
直肠脱垂最好通过腹腔内或会阴手术进行治疗，这些手术要么切除多余的直肠乙状结肠，要么将直肠固定在盆腔内。我们发现，对于高风险患者或仅存在轻度至中度直肠脱垂的患者，蒂尔施手术是一种充分的治疗方法。在过去20年中，我们采用改良的蒂尔施手术治疗了15例患者，使用针织涤纶血管移植物环绕肛门。1例患者在使用钢丝进行的蒂尔施手术失败后，里普斯坦手术也失败，之后需要进行第二次蒂尔施手术。2例患者因缝线断裂、1例患者因移除感染的移植物后需要进行第二次蒂尔施手术。另外2例患者发生移植物感染，需要移除涤纶移植物；1例患者发生肛周感染，未移除移植物即得到治疗。9例先前失禁的患者中有6例实现了控便，6例术前有控便能力的患者维持了控便。15例患者中有13例的脱垂得到纠正。虽然蒂尔施手术并不适用于所有直肠脱垂患者，但操作得当的话可以成功应用。
