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改良吻合器经肛门直肠切除术治疗局限性直肠脱垂:Delorme手术的可行替代方案

Modified Stapled Transanal Rectal Resection Procedure for Limited Rectal Prolapse: A Viable Alternative to the Delorme Operation.

作者信息

Chen Hua-Xian, Chen Zu-Qing, Huang Liang, Han Chang-Peng, Dou Ruo-Xu, Ren Dong-Lin, Lin Hong-Cheng

机构信息

Department of Colorectal Surgery, 66278The First People's Hospital of Foshan, People's Republic of China.

Department of Colorectal Surgery, People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, People's Republic of China.

出版信息

Surg Innov. 2020 Oct;27(5):468-473. doi: 10.1177/1553350620929470. Epub 2020 Jun 8.

Abstract

. The optimal surgical approach for full-thickness rectal prolapse (FTRP) remains controversial. In China, patients with limited FTRP (<5 cm in length) are usually managed by perineal surgery. We retrospectively assessed the outcome of Delorme's procedure and compared it with modified stapled transanal rectal resection (STARR). . The study was conducted in 2 public tertiary referral centers in China with modified STARR or Delorme's procedure performed by experienced surgeons. Outcomes assessed recurrence, operative times, blood loss, complications, length of hospital stay, and continence and constipation scoring. . Between December 2012 and May 2019, 65 patients were assessed, including 48 with modified STARR (group 1) and 17 with Delorme's procedure (group 2). The median follow-up was 22 months (range, 3-86 months). The mean operative time for group 1 was 37.4 ± 17.5 minutes vs 74.3 ± 30.6 minutes for group 2 ( < .001). The blood loss for group 1 was significantly lower than that for group 2 (17.4 ± 15.9 mL vs 27.8 ± 16.7 mL, respectively; = .028). There was no significant difference between groups in recurrence (group 1 18.8% vs group 2 23.5%; = .944) with no effect of operation type. Both procedures showed improvement in constipation and continence scoring with a similar impact. . Modified STARR and the Delorme operation are comparable in managing limited FTRP with superior results in operative time and blood loss for STARR.

摘要

全层直肠脱垂(FTRP)的最佳手术方式仍存在争议。在中国,FTRP程度较轻(长度<5厘米)的患者通常采用经会阴手术治疗。我们回顾性评估了德洛姆手术的结果,并将其与改良经肛门吻合器直肠切除术(STARR)进行比较。本研究在中国的2家公立三级转诊中心开展,由经验丰富的外科医生实施改良STARR或德洛姆手术。评估的结果包括复发情况、手术时间、失血量、并发症、住院时间以及控便和便秘评分。在2012年12月至2019年5月期间,共评估了65例患者,其中48例行改良STARR手术(第1组),17例行德洛姆手术(第2组)。中位随访时间为22个月(范围3 - 86个月)。第1组的平均手术时间为37.4±17.5分钟,而第2组为74.3±30.6分钟(P<0.001)。第1组的失血量显著低于第2组(分别为17.4±15.9毫升和27.8±16.7毫升;P = 0.028)。两组在复发方面无显著差异(第1组为18.8%,第2组为23.5%;P = 0.944),手术类型对此无影响。两种手术在便秘和控便评分方面均有改善,且影响相似。改良STARR手术和德洛姆手术在治疗轻度FTRP方面效果相当,STARR手术在手术时间和失血量方面更具优势。

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