Wang Benjun, Han Weiwei, Zhai Yuze, Shi Renjie
First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China.
Department of Anorectal Surgery, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China.
Front Surg. 2024 Feb 5;11:1340500. doi: 10.3389/fsurg.2024.1340500. eCollection 2024.
Our research introduces an innovative surgical approach, combining the Altemeier Procedure with Sigmoido-rectal Intussusception Anastomosis, effectively reducing recurrence, minimizing complications, and improving postoperative anal function in rectal prolapse patients.
This retrospective study, conducted at tertiary referral hospitals including Shandong University of Traditional Chinese Medicine's Affiliated Hospital, Linyi People's Hospital, and Pingyi People's Hospital, examined data from patients undergoing conventional Altemeier surgery or Altemeier combined with Sigmoido-rectal Intussusception Anastomosis. Analyzing hospitalization and follow-up data from January 2009 to December 2022, the study focused on prolapse recurrence, complications, and anal function as primary outcome indicators across these three study centers.
In the study, both groups had an average follow-up of (12.5 ± 2.41) months, and only two traditional group patients experienced mortality. Recurrence rates significantly differed, with 26.47% in the traditional group and 1.54% in the modified group (< 0.001). The modified group showed no perioperative anastomotic dehiscence, contrasting with a 13.24% occurrence in the conventional group (= 0.003). Primary complications in the modified group included anastomotic hemorrhage, with rates of 17.65% and 6.15% in the traditional and modified groups, respectively (= 0.077). At 12 months postoperatively, both groups improved in anal manometry parameters and the Wexner anal incontinence score. Resting pressure was significantly lower in the traditional group (32.50 ± 1.76 mmHg) than the modified group (33.24 ± 2.06 mmHg) (= 0.027), while the extrusion pressure was higher in the modified group (64.78 ± 1.55 mmHg) than the traditional group (62.85 ± 2.30 mmHg) ( < 0.001). The Wexner anal incontinence score was significantly lower in the modified group (2.69 ± 1.65) than the traditional group (3.69 ± 1.58, = 0.001).
This retrospective study affirms that adding Sigmoido-rectal Intussusception Anastomosis to the Altemeier procedure reduces recurrence and complications. While both approaches enhance postoperative anal function in complete rectal prolapse patients, the combined method, particularly with Sigmoido-rectal Intussusception Anastomosis, proves more effective.
我们的研究引入了一种创新的手术方法，将阿尔特迈尔手术与乙状结肠直肠套叠吻合术相结合，有效降低复发率，减少并发症，并改善直肠脱垂患者的术后肛门功能。
这项回顾性研究在包括山东中医药大学附属医院、临沂市人民医院和平邑县人民医院在内的三级转诊医院进行，研究对象为接受传统阿尔特迈尔手术或阿尔特迈尔联合乙状结肠直肠套叠吻合术的患者。通过分析2009年1月至2022年12月期间的住院和随访数据，该研究将脱垂复发、并发症和肛门功能作为这三个研究中心的主要结局指标。
在该研究中，两组的平均随访时间为（12.5±2.41）个月，传统组仅有2例患者死亡。复发率存在显著差异，传统组为26.47%，改良组为1.54%（P<0.001）。改良组未出现围手术期吻合口裂开，而传统组的发生率为13.24%（P = 0.003）。改良组的主要并发症为吻合口出血，传统组和改良组的发生率分别为17.65%和6.15%（P = 0.077）。术后12个月时，两组的肛门测压参数和韦克斯纳肛门失禁评分均有所改善。传统组的静息压力（32.50±1.76 mmHg）显著低于改良组（33.24±2.06 mmHg）（P = 0.027），而改良组的挤压压力（64.78±1.55 mmHg）高于传统组（62.85±2.30 mmHg）（P<0.001）。改良组的韦克斯纳肛门失禁评分（2.69±1.65）显著低于传统组（3.69±1.58，P = 0.001）。
这项回顾性研究证实，在阿尔特迈尔手术中增加乙状结肠直肠套叠吻合术可降低复发率和并发症。虽然两种方法都能改善完全性直肠脱垂患者的术后肛门功能，但联合方法，特别是结合乙状结肠直肠套叠吻合术，被证明更有效。
