在加拿大的两家学术医院比较经会阴吻合器直肠前突切除术与 Altemeier 手术。
A comparison of perineal stapled prolapse resection and the Altemeier procedure at 2 Canadian academic hospitals.
机构信息
From the Department of Surgery, University of Manitoba, Winnipeg, Man. (Haven); the Department of Surgery, University of Saskatchewan, Saskatoon, Sask. (Baig, Gill, Ginther); and the Department of Surgery, University of British Columbia, Vancouver, BC (Karimuddin, Raval, Brown, Phang)
From the Department of Surgery, University of Manitoba, Winnipeg, Man. (Haven); the Department of Surgery, University of Saskatchewan, Saskatoon, Sask. (Baig, Gill, Ginther); and the Department of Surgery, University of British Columbia, Vancouver, BC (Karimuddin, Raval, Brown, Phang).
出版信息
Can J Surg. 2023 Jan 3;66(1):E8-E12. doi: 10.1503/cjs.008421. Print 2023 Jan-Feb.
BACKGROUND
The preferred perineal repair method for full-thickness rectal prolapse is the Altemeier procedure, a perineal proctosigmoidectomy with handsewn anastomosis. A recently described variant of this procedure combines the resection and anastomosis into 1 step by means of linear and transverse stapling. There are few published data comparing the characteristics and outcomes of these 2 approaches.
METHODS
This retrospective review, performed at 2 Canadian academic hospitals, compares surgical and cost outcomes between the perineal stapled prolapse resection (PSPR) and the Altemeier procedure. All patients who underwent these procedures between 2015 and 2019 were included.
RESULTS
There were 25 patients in the PSPR group and 19 in the Altemeier group. Patients in the PSPR group were significantly older than those in the Altemeier group (81 [95% confidence interval (CI) 70-92] yr v. 74 [95% CI 63-85] yr; = 0.047), had a lower body mass index (21.4 [95% CI 17.7-25.1] v. 24.4 [95% CI 18.5-30.3]; = 0.042) and had equivalent American Society of Anesthesiologists scores (2.84 [95% CI 2.09-3.59] v. 2.68 [95% CI 1.93-3.43]; = 0.49). The operative time for PSPR was significantly less (30.3 [95% CI 16.3-44.3] min v. 67 [95% CI 43-91] min; < 0.001), as were the operative costs. Recurrence (28.0% v. 36.8%; = 0.53) and complication rates were equivalent.
CONCLUSION
PSPR is a safe, efficient and effective approach to perineal proctosigmoidectomy. It is associated with surgical outcomes comparable to those of the Altemeier procedure, but with a significant reduction in operative time and cost.
背景
全层直肠脱垂的首选会阴修复方法是 Altemeier 手术，即会阴直肠-乙状结肠切除术并手工吻合。最近描述的该手术的一种变体通过线性和横向吻合器将切除和吻合合为一步。比较这两种方法的特征和结果的已发表数据很少。
方法
本回顾性研究在加拿大的 2 所学术医院进行，比较会阴吻合器直肠脱垂切除术（PSPR）和 Altemeier 手术的手术和成本结果。纳入 2015 年至 2019 年间行这些手术的所有患者。
结果
PSPR 组有 25 例患者，Altemeier 组有 19 例患者。PSPR 组患者明显比 Altemeier 组患者年龄大（81 [95%置信区间（CI）70-92]岁比 74 [95% CI 63-85]岁；= 0.047），体重指数较低（21.4 [95% CI 17.7-25.1]比 24.4 [95% CI 18.5-30.3]；= 0.042），美国麻醉医师协会评分相当（2.84 [95% CI 2.09-3.59]比 2.68 [95% CI 1.93-3.43]；= 0.49）。PSPR 的手术时间明显更短（30.3 [95% CI 16.3-44.3]分钟比 67 [95% CI 43-91]分钟；< 0.001），手术费用也更低。复发率（28.0%比 36.8%；= 0.53）和并发症发生率相当。
结论
PSPR 是会阴直肠-乙状结肠切除术的一种安全、有效且有效的方法。它与 Altemeier 手术的手术结果相当，但手术时间和成本显著降低。
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