Department of digestive and general surgery, Aix Marseille university, Timone hospital, Assistance publique-Hopitaux de Marseille (AP-HM), 13354 Marseille, France.
Department of digestive and general surgery, Aix Marseille university, Timone hospital, Assistance publique-Hopitaux de Marseille (AP-HM), 13354 Marseille, France.
J Visc Surg. 2021 Apr;158(2):145-157. doi: 10.1016/j.jviscsurg.2020.10.001. Epub 2021 Jan 22.
Rectocele is defined as a hernia of the rectum with protrusion of the anterior rectal wall through the posterior wall of the vagina. This condition occurs commonly, with an estimated prevalence of 30-50% of women over age 50. The symptomatology that leads to consultation is variable but consists predominantly of anorectal and/or gynecological complaints such as dyschezia, requiring digital disimpaction maneuvers, pelvic heaviness, anal incontinence, or dyspareunia. Rectocele may be isolated or associated with other disorders of pelvic stasis involving cystocele and uterine prolapse. Complementary exams (dynamic imaging and anorectal manometry) are essential before deciding on the surgical management of this condition. The indications for surgical management of rectocele are based on the intensity of symptoms and the resulting deterioration in quality of life, and surgery should be discussed after failure of medical treatment. Different approaches are possible, although there is currently no real consensus in the literature. The initial approach depends on the type of rectocele: if it involves the low or mid rectum or is isolated, an approach from below (transanal, transperineal, or transvaginal approach) can be proposed, while, in the presence of a high rectocele and/or associated with various disorders of pelvic stasis, transabdominal rectopexy is more suitable.
直肠前突是指直肠通过阴道后壁突出，属于直肠前壁疝。这种情况很常见，据估计，50 岁以上女性的患病率为 30%至 50%。导致就诊的症状各不相同，但主要包括肛肠和/或妇科方面的主诉，如排便困难，需要进行手指扩肛，盆腔沉重感，肛门失禁，或性交困难。直肠前突可能是孤立的，也可能与其他盆腔淤滞性疾病（如膀胱膨出和子宫脱垂）同时存在。在决定手术治疗这种疾病之前，需要进行补充检查（动态影像学和肛肠测压）。直肠前突手术治疗的适应证基于症状的严重程度和生活质量的下降程度，并且应在药物治疗失败后讨论手术治疗。尽管目前文献中尚无真正的共识，但有多种可能的治疗方法。初始治疗方法取决于直肠前突的类型：如果涉及直肠下段或中段，且为孤立性，则可以选择从下方入路（经肛门、经会阴或经阴道入路）；如果是高位直肠前突和/或伴有各种盆腔淤滞性疾病，则更适合经腹直肠固定术。
