Schultz I, Mellgren A, Dolk A, Johansson C, Holmström B
Department of Surgery, Karolinska Institutet at Danderyd Hospital, Stockholm, Sweden.
Dis Colon Rectum. 1996 Mar;39(3):300-6. doi: 10.1007/BF02049472.
This study was undertaken to evaluate anal manometric changes after Ripstein's operation for rectal prolapse and rectal intussusception and to study the clinical outcome following the operation, with special reference to anal incontinence.
Forty-two patients with rectal prolapse or rectal intussusception were subjected to anorectal manometry preoperatively and seven days and six months postoperatively. A detailed history was obtained from each patient preoperatively and six months postoperatively.
Preoperatively, patients with rectal intussusception had higher maximum resting pressure (MRP) (52+/- 23 mmHg) than patients with rectal prolapse (34 +/- 20 mmHg; P < 0.01). In the group of patients with rectal prolapse, there was a postoperative increase in MRP after six months (P < 0.001) but not after seven days. Maximum squeeze pressure (MSP) did not increase. Neither MRP nor MSP increased postoperatively in patients with internal rectal procidentia. Continence was improved postoperatively both in patients with rectal prolapse (P < 0.01) and rectal intussusception (P < 0.01). There was no postoperative increase in rectal emptying difficulties.
Ripstein's operation often improved anal continence in patients with rectal prolapse and rectal intussusception. This improvement was accompanied by increased MRP in patients with rectal prolapse, indicating recovery of internal anal sphincter function. No postoperative increase in MRP was found in patinets with rectal intussusception. This suggests an alternate mechanism of improvement in patients with rectal intussusception.
本研究旨在评估里普斯坦手术治疗直肠脱垂和直肠套叠后肛门测压的变化，并研究该手术后的临床结局，特别关注肛门失禁情况。
对42例直肠脱垂或直肠套叠患者在术前、术后7天和术后6个月进行肛肠测压。术前和术后6个月从每位患者处获取详细病史。
术前，直肠套叠患者的最大静息压（MRP）（52±23mmHg）高于直肠脱垂患者（34±20mmHg；P<0.01）。在直肠脱垂患者组中，术后6个月MRP升高（P<0.001），但术后7天未升高。最大收缩压（MSP）未升高。直肠内脱垂患者术后MRP和MSP均未升高。直肠脱垂患者（P<0.01）和直肠套叠患者（P<0.01）术后控便能力均得到改善。术后直肠排空困难没有增加。
里普斯坦手术常能改善直肠脱垂和直肠套叠患者的肛门控便能力。这种改善伴随着直肠脱垂患者MRP的升高，表明肛门内括约肌功能恢复。直肠套叠患者术后未发现MRP升高。这提示直肠套叠患者存在另一种改善机制。
