Colorectal Surgery department, Nepean Hospital, Kingswood, New South Wales, Australia.
Department of Surgery, Nepean Private Hospital, Kingswood, New South Wales, Australia.
Colorectal Dis. 2020 Dec;22(12):1850-1861. doi: 10.1111/codi.15338. Epub 2020 Sep 21.
Rectal prolapse is an uncommon but debilitating pelvic floor disorder that significantly decreases the quality of life of affected patients. Perineal stapled prolapse resection is a relatively new perineal approach that offers an promising alternative technique in the surgical management of rectal prolapse. It appears to be a simple, reproducible and efficient method. However, long-term outcomes are limited. The aims of this review are to assess the safety and effectiveness of perineal stapled prolapse resection in the management of rectal prolapse.
A systematic review of all articles describing this approach was searched using MEDLINE, Embase, PubMed, Cochrane, Scopus, Web of Science and China National Knowledge Infrastructure. Included in this review were all randomized and nonrandomized prospective and retrospective studies reporting patients (aged 16 years and older) with complete rectal prolapse who underwent perineal stapled prolapse resection for the surgical treatment of the rectal prolapse.
A total of 408 patients across 20 articles were included. There were 58 cases of recurrence out of 368 patients over a median length of follow-up of 18 months (interquartile range 12-34 months). The total weighted overall recurrence was 12%. There were 51 cases of postoperative complications in 350 cases, bleeding being the most common complication.
The recurrence rate is comparable to those of the well-established Altemeier and Delorme procedures. However, given the heterogeneity of studies and variations in lengths of follow-up, further randomized prospective studies are needed to adequately compare this technique against other procedures for complete rectal prolapse.
直肠脱垂是一种罕见但使人虚弱的盆底功能障碍，严重降低了受影响患者的生活质量。经会阴吻合器直肠脱垂切除术是一种相对较新的会阴入路方法，为直肠脱垂的外科治疗提供了一种有前途的替代技术。它似乎是一种简单、可重复和有效的方法。然而，长期结果是有限的。本综述的目的是评估经会阴吻合器直肠脱垂切除术在直肠脱垂治疗中的安全性和有效性。
使用 MEDLINE、Embase、PubMed、Cochrane、Scopus、Web of Science 和中国国家知识基础设施（CNKI）系统地检索了所有描述这种方法的文章。本综述纳入了所有描述经会阴吻合器直肠脱垂切除术治疗完全性直肠脱垂的前瞻性和回顾性随机和非随机研究，纳入患者年龄均≥16 岁。
共有 20 篇文章的 408 例患者纳入本研究。在中位随访 18 个月（12-34 个月）时，368 例中有 58 例复发。总加权复发率为 12%。350 例中有 51 例发生术后并发症，最常见的并发症是出血。
复发率与 Altemeier 和 Delorme 等经典术式相当。然而，鉴于研究的异质性和随访时间的不同，需要进一步的随机前瞻性研究来充分比较该技术与其他完全性直肠脱垂手术方法。
