Chan W K, Kay S M, Laberge J M, Gallucci J G, Bensoussan A L, Yazbeck S
Department of Pediatric Surgery, The Montreal Children's Hospital, McGill University, Quebec, Canada.
J Pediatr Surg. 1998 Feb;33(2):255-8. doi: 10.1016/s0022-3468(98)90441-9.
The aim of this study was to examine the efficacy of injection sclerotherapy as treatment for persistent rectal prolapse.
The records of 28 patients with rectal prolapse treated with injection sclerotherapy over a 16-year period were reviewed. Initial management included assessment and correction of predisposing factors. If rectal prolapse persisted or if the prolapse required repeat emergency or operating room reduction, injection sclerotherapy was performed. The sclerosing agent included D50W in 21 patients (sole agent in 15, combined with ethanolamine oleate in four, and with phenol 5% in two). Phenol 5% alone was used in six patients, and 25% saline was used in one patient. Number of injections, recurrences, and complications were reviewed.
Two patients were lost to follow-up, and one patient was cured once a polyp was recognized and removed. Of the remaining 25 patients, 21 were cured. Sixteen required one injection, three required two injections, and two required three injections (64% cure rate after one injection, 84% cure rate after three injections). There were 4 of 25 failures: two went on to low anterior resection after having failed two injections each; one patient was treated with Thiersch cerclage and injection after two failed injections; and one patient did not respond after three injections but had less severe prolapses. Of those injected with D50W alone, 13 of 14 were cured with injection sclerotherapy. Nine received one injection, two received two injections, and two received three injections (64% cure rate after one injection, 93% cure rate after three injections). The only complication was excessive oozing at the injection site in one patient. He was simply observed in hospital overnight. Follow-up averaged 33 months. The only significant underlying abnormality in our patient population was spina bifida in one patient. This patient was cured with injection therapy. Cystic fibrosis was ruled out by clinical examination and sweat chloride test in all patients. Constipation was the most common condition identified with the onset of rectal prolapse (15 of 28).
Injection sclerotherapy is simple and should be considered as the first line treatment of recurrent rectal prolapse after failure of conservative measures. D50W is effective, easily available, inexpensive, and associated with few complications.
本研究旨在探讨注射硬化疗法治疗持续性直肠脱垂的疗效。
回顾了16年间28例接受注射硬化疗法治疗的直肠脱垂患者的记录。初始治疗包括评估和纠正诱发因素。如果直肠脱垂持续存在，或者脱垂需要重复急诊复位或手术室复位，则进行注射硬化疗法。硬化剂包括21例患者使用50%葡萄糖溶液（15例单独使用，4例与油酸乙醇胺联合使用，2例与5%苯酚联合使用）。6例患者单独使用5%苯酚，1例患者使用25%盐水。回顾了注射次数、复发情况和并发症。
2例患者失访，1例患者在发现并切除息肉后治愈。其余25例患者中，21例治愈。16例患者需要注射1次，3例患者需要注射2次，2例患者需要注射3次（注射1次后的治愈率为64%，注射3次后的治愈率为84%）。25例中有4例治疗失败：2例在每次注射2次失败后进行了低位前切除术；1例患者在2次注射失败后接受了蒂尔施缝扎术和注射治疗；1例患者在注射3次后无反应，但脱垂程度较轻。在仅注射50%葡萄糖溶液的患者中，14例中有13例通过注射硬化疗法治愈。9例接受1次注射，2例接受2次注射，2例接受3次注射（注射1次后的治愈率为64%，注射3次后的治愈率为93%）。唯一的并发症是1例患者注射部位渗血过多。他仅在医院观察了一夜。平均随访33个月。我们患者群体中唯一显著的潜在异常是1例患者患有脊柱裂。该患者通过注射疗法治愈。所有患者均通过临床检查和汗液氯化物试验排除了囊性纤维化。便秘是直肠脱垂发病时最常见的情况（28例中有15例）。
注射硬化疗法简单，应被视为保守措施失败后复发性直肠脱垂的一线治疗方法。50%葡萄糖溶液有效、易于获得、价格低廉且并发症少。
