Yokoyama Sachio, Ikuta Yoshiaki, Tsukamoto Masayo, Yamao Takanobu
Department of Gastroenterological Surgery, Kumamoto City Hospital, Kumamoto, Japan.
J Anus Rectum Colon. 2022 Jul 28;6(3):190-194. doi: 10.23922/jarc.2021-068. eCollection 2022.
Rectal prolapse (RP) most commonly occurs among elderly women and is caused by vulnerable suspensory tissue in the pelvis. In Japan, the Gant-Miwa-Thiersch procedure (GMT) is recommended for elderly people with poor general health. We retrospectively analyzed clinical data from 12 patients who underwent GMT at our hospital from September 2005 to July 2021 and investigated the effect of GMT on the mesorectum using abdominal-pelvic computed tomography (CT) performed for other diseases. The median age of the cohort was 82 years, and 92% of the subjects were women. The median RP length was 5 cm, and the median follow-up period was 60 months. Recurrence was observed in 1 of 12 patients (8.0%). CT conducted before and more than 6 months after GMT revealed no abnormal findings in the mesorectum, whereas CT within 5 months after GMT revealed hyperdense fat in the mesorectum in all three patients (100%; < 0.05). The RP recurrence rate after the GMT was low. The mechanism of the effect of GMT may involve not only a direct mucosal plicating effect but also adhesional rectosacral fixation due to the presence of inflammation extending to the mesorectum.
直肠脱垂（RP）最常见于老年女性，由盆腔内脆弱的悬吊组织引起。在日本，对于全身健康状况较差的老年人，推荐采用甘特-三泽-蒂尔施手术（GMT）。我们回顾性分析了2005年9月至2021年7月在我院接受GMT手术的12例患者的临床资料，并利用因其他疾病进行的腹盆腔计算机断层扫描（CT）研究了GMT对直肠系膜的影响。该队列的中位年龄为82岁，92%的受试者为女性。直肠脱垂的中位长度为5 cm，中位随访期为60个月。12例患者中有1例（8.0%）出现复发。GMT术前及术后6个月以上进行的CT检查显示直肠系膜无异常发现，而GMT术后5个月内进行的CT检查显示所有3例患者（100%；P<0.05）的直肠系膜内有高密度脂肪。GMT术后直肠脱垂的复发率较低。GMT的作用机制可能不仅涉及直接的黏膜折叠作用，还涉及由于炎症蔓延至直肠系膜而导致的粘连性直肠骶骨固定。
