Hu Bang, Zou Qi, Xian Zhenyu, Su Dan, Liu Chao, Lu Li, Luo Minyi, Chen Zixu, Cai Keyu, Gao Han, Peng Hui, Cao Wuteng, Ren Donglin
Department of Colorectal and Anal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China.
Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China.
Gastroenterol Rep (Oxf). 2022 Feb 21;10(1):goac007. doi: 10.1093/gastro/goac007. eCollection 2022 Feb.
External rectal prolapse is a relatively rare disease, in which male patients account for a minority. The selection of abdominal repair or perineal repair for male patients has rarely been investigated.
Fifty-one male patients receiving abdominal repair (laparoscopic ventral rectopexy) or perineal repair (Delorme or Altemeier procedures) at the Sixth Affiliated Hospital of Sun Yat-sen University (Guangzhou, China) between March 2013 and September 2019 were retrospectively analysed. We compared the recurrence, complication rate, post-operative defecation disorder, length of stay, and quality of life between the abdominal and perineal groups.
Of the 51 patients, 45 had a complete follow-up, with a median of 48.5 months (range, 22.8-101.8 months). A total of 35 patients were under age 40 years. The complication rate associated with abdominal repair was less than that associated with perineal repair (0% vs 20.7%, = 0.031) and the recurrence rate was also lower (9.5% vs 41.7%, 0.018). Multivariate analysis showed that perineal repair (odds ratio, 9.827; 95% confidence interval, 1.296-74.50; = 0.027) might be a risk factor for recurrence. Moreover, only perineal repair significantly improved post-operative constipation status (preoperative vs post-operative, 72.4% vs 25.0%, 0.001). There was no reported mortality in either of the groups. No patient's sexual function was affected by the surgery.
Both surgical approaches were safe in men. Compared with perineal repair, the complication rate and recurrence rate for abdominal repair were lower. However, perineal repair was better able to correct constipation.
直肠外脱垂是一种相对罕见的疾病，男性患者占少数。对于男性患者，腹部修复或会阴修复的选择很少被研究。
回顾性分析2013年3月至2019年9月在中山大学附属第六医院（中国广州）接受腹部修复（腹腔镜直肠悬吊术）或会阴修复（德洛姆或阿尔特迈尔手术）的51例男性患者。我们比较了腹部组和会阴组之间的复发率、并发症发生率、术后排便障碍、住院时间和生活质量。
51例患者中，45例获得了完整的随访，中位随访时间为48.5个月（范围22.8 - 101.8个月）。共有35例患者年龄在40岁以下。腹部修复相关的并发症发生率低于会阴修复（0%对20.7%，P = 0.031），复发率也较低（9.5%对41.7%，P = 0.018）。多因素分析显示，会阴修复（比值比，9.827；95%置信区间，1.296 - 74.50；P = 0.027）可能是复发的危险因素。此外，只有会阴修复显著改善了术后便秘状况（术前对术后，72.4%对25.0%，P = 0.001）。两组均未报告死亡病例。手术未影响任何患者的性功能。
两种手术方法对男性均安全。与会阴修复相比，腹部修复的并发症发生率和复发率较低。然而，会阴修复在纠正便秘方面效果更好。
