腹腔镜直肠后固定术治疗完全性直肠脱垂的有效性：一项队列研究。

Usefulness of laparoscopic posterior rectopexy for complete rectal prolapse: A cohort study.

机构信息

Department of Surgery, Kobe City Medical Center General Hospital, Kobe, Japan.

Department of Pediatric Surgery, Kitano Hospital, Osaka, Japan.

出版信息

Int J Surg. 2019 Dec;72:109-114. doi: 10.1016/j.ijsu.2019.10.024. Epub 2019 Nov 6.

DOI:10.1016/j.ijsu.2019.10.024

PMID:31704417

Abstract

BACKGROUND

Transabdominal rectopexy for complete rectal prolapse reportedly yields more definitive results than transperineal surgery. Recently, minimally invasive laparoscopic rectopexy has become a popular treatment option for patients with rectal prolapse. Herein, we describe our surgical procedure for correction of rectal prolapse. We further aimed to perform a comparative assessment between perioperative outcomes achieved with open and laparoscopic applications of this technique.

MATERIALS AND METHODS

In this cohort study, 65 patients underwent posterior rectopexy (laparoscopic, 50; open, 15) between April 2008 and December 2015. The basic procedure consisted of posterior rectopexy using mesh fixation (modified Wells' method). We assessed and compared perioperative outcomes (duration of surgery and hospitalization, complication rates, blood-loss, degree of fecal incontinence) of laparoscopic and open rectopexy. Furthermore, pre- and post-operative urinary incontinence was measured (using pad test, questionnaire) and compared to determine the effects of the procedure on pelvic organ function. A p-value <0.05 indicated statistical significance.

RESULTS

The mean operative time of the laparoscopic and open procedures was 127 and 83.6 min, respectively. The amount of blood-loss was negligible and 77 (range, 18-200) g with the laparoscopic and open approaches, respectively. The mean duration of hospitalization was 4.2 and 7.2 days for the former and latter procedures, respectively (p < 0.05). Rectal prolapse and fecal incontinence (evaluated using Wexner's score) diminished in all patients. Urinary incontinence also decreased postoperatively. There were no recurrences of rectal prolapse.

CONCLUSION

Laparoscopic rectopexy can be safely performed in older patients to achieve early postoperative ambulation and significantly shorten the hospital-stay. It may therefore be considered an effective treatment for complete rectal prolapse and urinary dysfunction.

摘要

背景

经腹直肠固定术治疗完全性直肠脱垂的效果比经会阴手术更确切。最近，微创腹腔镜直肠固定术已成为直肠脱垂患者的一种流行治疗选择。在此，我们描述了我们治疗直肠脱垂的手术方法。我们还旨在对经开放和腹腔镜应用该技术获得的围手术期结果进行比较评估。

材料和方法

在这项队列研究中，2008 年 4 月至 2015 年 12 月期间，有 65 例患者接受了后路直肠固定术（腹腔镜 50 例，开放 15 例）。基本手术过程包括使用网片固定的后路直肠固定术（改良 Wells 法）。我们评估并比较了腹腔镜和开放直肠固定术的围手术期结果（手术时间和住院时间、并发症发生率、失血量、粪便失禁程度）。此外，还测量了术前和术后尿失禁（使用尿垫试验、问卷调查），以确定该手术对盆腔器官功能的影响。p 值<0.05 表示有统计学意义。

结果

腹腔镜和开放手术的平均手术时间分别为 127 和 83.6 分钟。失血量可忽略不计，腹腔镜和开放手术分别为 77（范围，18-200）g。前者和后者的平均住院时间分别为 4.2 和 7.2 天（p<0.05）。所有患者的直肠脱垂和粪便失禁（用 Wexner 评分评估）均减轻。术后尿失禁也减少。没有直肠脱垂复发。