Cundiff G W, Weidner A C, Visco A G, Addison W A, Bump R C
Division of Gynecologic Specialties, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina, USA.
Am J Obstet Gynecol. 1998 Dec;179(6 Pt 1):1451-6; discussion 1456-7. doi: 10.1016/s0002-9378(98)70009-2.
The aim of this study was to describe the anatomic and functional results of the discrete fascial defect rectocele repair.
Sixty-nine women underwent rectocele repair at Duke University Medical Center during a 3-year period beginning January 1, 1994. Repair was limited to reapproximation of discrete defects in the rectovaginal fascia, without levator plication or perineorrhaphy. Outcome measures included Pelvic Organ Prolapse Quantitation measurements, prolapse stage, and a symptom questionnaire. Univariate and nonparametric tests were used as appropriate.
Before the operation 46% patients (32/69) reported constipation, 39% (27/69) reported splinting, 32% (22/69) reported tenesmus, and 13% (9/69) reported fecal incontinence. The median preoperative posterior Pelvic Organ Prolapse Quantitation stage was 2 (1-4). Pelvic Organ Prolapse Quantitation stage had improved for all but 2 women at 6 weeks. Eighteen percent (8/43) had recurrent rectoceles at 12 months. Mean values for the points describing the posterior vaginal wall improved >2 cm (P <.0001). Although perineorrhaphy was not performed, the genital hiatus decreased by 2. 3 cm (P <.0001), with no significant change in the length of the perineal body. Functional results mirrored anatomic results, with statistically significant improvements for all symptoms.
The discrete defect rectocele repair provides anatomic correction of rectoceles with alleviation of associated symptoms for most women.
本研究旨在描述离散性筋膜缺损直肠膨出修补术的解剖学和功能学结果。
1994年1月1日起的3年期间，69名女性在杜克大学医学中心接受了直肠膨出修补术。修补仅限于重新对合直肠阴道筋膜中的离散性缺损，不进行提肌折叠或会阴修补术。结局指标包括盆腔器官脱垂定量测量、脱垂分期和症状问卷。酌情使用单变量和非参数检验。
术前，46%的患者（32/69）报告有便秘，39%（27/69）报告有屏气排便，32%（22/69）报告有里急后重，13%（9/69）报告有大便失禁。术前盆腔器官脱垂定量测量后位的中位数分期为2期（1 - 4期）。6周时，除2名女性外，所有患者的盆腔器官脱垂定量分期均有改善。12个月时，18%（8/43）出现复发性直肠膨出。描述阴道后壁的各点平均值改善超过2 cm（P <.0001）。尽管未进行会阴修补术，但生殖裂孔减少了2.3 cm（P <.0001），会阴体长度无显著变化。功能学结果与解剖学结果一致，所有症状均有统计学意义的改善。
离散性缺损直肠膨出修补术可为大多数女性提供直肠膨出的解剖学矫正并缓解相关症状。
