Maeda Kotaro, Honda Katsuyuki, Koide Yoshikazu, Katsuno Hidetoshi, Hanai Tsunekazu, Masumori Koji, Matsuoka Hiroshi, Endo Tomoyoshi, Cheong Yeong Cheol
International Medical Center Fujita Health University Hospital, Toyoake, Japan.
Division of Surgery, Rokuwa Hospital, Inazawa, Japan.
J Anus Rectum Colon. 2021 Apr 28;5(2):137-143. doi: 10.23922/jarc.2020-062. eCollection 2021.
To clarify the long-term outcomes of transvaginal anterior levatorplasty with posterior colporrhaphy for symptomatic rectocele with defecographic changes.
Consecutive patients undergoing transvaginal anterior levatorplasty with posterior colporrhaphy for symptomatic rectocele were prospectively registered and retrospectively reviewed using medical records. Symptoms, fecal incontinence, and defecographic findings were evaluated before and after surgery.
Fifty-seven women (mean age, 68 years) were identified, and the median disease duration was 24 months. Symptoms of vaginal mass (n 32) and difficult defecation (n 21) disappeared (90.6% and 71.4%, respectively) or improved (6.3% and 28.6%, respectively) after surgery. However, the feeling of residual stool was unchanged in two of eight patients. Seventeen patients who performed digitation on defecation before surgery discontinued digitation after surgery. The proportion of patients who had fecal incontinence preoperatively (40.4%) decreased significantly after surgery (17.5%) during a median follow-up period of 47 months. Defecography revealed a disappearance or improvement of rectocele in all 18 patients examined. The average rectocele size decreased significantly in six improved patients ( 0.0006, paired t-test).
Transvaginal anterior levatorplasty with posterior colporrhaphy for symptomatic rectocele was a useful option to improve symptoms and anatomical disorders in the long term, but it had limitations in improving defecatory symptoms.
明确经阴道前盆底修复术联合阴道后壁修补术治疗有排粪造影改变的症状性直肠膨出的长期疗效。
对连续接受经阴道前盆底修复术联合阴道后壁修补术治疗症状性直肠膨出的患者进行前瞻性登记，并通过病历进行回顾性分析。对手术前后的症状、大便失禁及排粪造影结果进行评估。
共纳入57例女性患者（平均年龄68岁），疾病中位持续时间为24个月。术后阴道肿物症状（32例）和排便困难症状（21例）消失（分别为90.6%和71.4%）或改善（分别为6.3%和28.6%）。然而，8例患者中有2例术后残留便意未改变。术前排便时需手指辅助的17例患者术后停止了手指辅助排便。在中位随访期47个月期间，术前有大便失禁的患者比例（40.4%）术后显著下降（17.5%）。排粪造影显示，所有18例接受检查的患者直肠膨出均消失或改善。6例改善患者的直肠膨出平均大小显著减小（配对t检验，P<0.0006）。
经阴道前盆底修复术联合阴道后壁修补术治疗症状性直肠膨出是一种长期改善症状和解剖结构紊乱的有效选择，但在改善排便症状方面存在局限性。
