Scaglia M, Fasth S, Hallgren T, Nordgren S, Oresland T, Hultén L
Department of Surgery, University of Göteborg, Sweden.
Dis Colon Rectum. 1994 Aug;37(8):805-13. doi: 10.1007/BF02050146.
The aim of this study was to investigate the influence of surgical technique on functional and manovolumetric results in patients treated with Marlex mesh abdominal rectopexy.
The lateral ligaments were completely divided (the Wells procedure) in 16 patients and preserved (the Ripstein procedure) in 16 patients. Clinical and physiologic assessment were performed before and at 3, 6, and 12 months after operation.
Improvement of continence was similar. Bowel regulation problems which were unchanged after the Ripstein procedure increased significantly after the Wells procedure (P < 0.01). Rectal volume became reduced in the group who received the Wells procedure (225 ml vs. 115 ml, P < 0.05 at one year), but remained unchanged after receiving the Ripstein procedure. The pressure thresholds required to elicit sensation of rectal filling and defecation urge were increased after the Wells procedure (15 cm of H2O vs. 25 cm of H2O, P < 0.05 and 25 cm of H2O vs. 45 cm of H2O, P < 0.05, respectively). In the Ripstein group there was only a slight increase of the threshold for urge (P < 0.05).
The Wells procedure was followed by severe rectal dysfunction accompanied by increased constipation and evacuation problems. The Ripstein procedure, preserving the lateral ligaments, appears not to affect such symptoms adversely. On the other hand, improvement is not likely to occur.
本研究旨在探讨手术技术对接受Marlex网片腹部直肠固定术患者的功能和压力容积结果的影响。
16例患者完全切断侧韧带（Wells手术），16例患者保留侧韧带（Ripstein手术）。在手术前以及术后3、6和12个月进行临床和生理评估。
控便能力的改善相似。Ripstein手术后未改变的肠道调节问题在Wells手术后显著增加（P<0.01）。接受Wells手术的组直肠容积减小（一年时225毫升对115毫升，P<0.05），但接受Ripstein手术后直肠容积保持不变。Wells手术后引发直肠充盈感和排便冲动所需的压力阈值增加（分别为15厘米水柱对25厘米水柱，P<0.05和25厘米水柱对45厘米水柱，P<0.05）。在Ripstein组中，冲动阈值仅略有增加（P<0.05）。
Wells手术后出现严重的直肠功能障碍，伴有便秘和排便问题增加。保留侧韧带的Ripstein手术似乎不会对这些症状产生不利影响。另一方面，但不太可能出现改善。
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