Pescatori M, Interisano A, Stolfi V M, Zoffoli M
Coloproctology Unit, Villa Flaminia, Rome, Italy.
Int J Colorectal Dis. 1998;13(5-6):223-7. doi: 10.1007/s003840050165.
Clinical and manometric results of Delorme's operation and sphincteroplasty were assessed retrospectively in patients undergoing this procedure for fecal incontinence and rectal prolapse. A series of 33 patients (11 males, 22 females; aged 18-83 years, mean 59) with external rectal prolapse were treated by Delorme's operation between 1989 and 1996. Mean follow-up was 39 months (range 7-84). Sphincteroplasty was associated in 12 cases with severe fecal incontinence due to striated muscle defects. Good results were achieved in 27 patients (79%); prolapse recurrence was observed in 6 (21%), the mean recurrence time being 9 months (range 1-24 months). There were no postoperative deaths. Minor complications occurred in 15 patients. Changes in preoperative and postoperative manometric patterns were as follows (mean +/- SEM): voluntary contraction from 59 +/- 6.9 to 66 +/- 7.1 mmHg (P = 0.05), resting tone from 33 +/- 5 to 32 +/- 4.3 mmHg, rectal sensation from 59 +/- 5 to 61 +/- 5.2 ml of air (n.s.). A solitary rectal ulcer syndrome was detected in five patients. The histological pattern demonstrated pathological changes in 40% of cases. Fecal incontinence was resolved in 6 of 20 cases (30%) and chronic constipation in 4 of 9 (44%). Failure (n = 3) was related primarily to postoperative sepsis. The incontinence score showed a mean improvement of 35% decreasing, from 4.5 +/- 0.39 to 2.9 +/- 0.44 after surgery (P < 0.01). In conclusion, Delorme's procedure did not lead to constipation and improved anal continence when associated with sphincteroplasty.
对因大便失禁和直肠脱垂而接受德洛姆手术和括约肌成形术的患者的临床和测压结果进行了回顾性评估。1989年至1996年间，对一系列33例（11例男性，22例女性；年龄18 - 83岁，平均59岁）直肠外脱垂患者进行了德洛姆手术治疗。平均随访时间为39个月（范围7 - 84个月）。12例因横纹肌缺陷导致严重大便失禁的患者同时进行了括约肌成形术。27例患者（79%）取得了良好效果；6例（21%）观察到脱垂复发，平均复发时间为9个月（范围1 - 24个月）。无术后死亡病例。15例患者出现轻微并发症。术前和术后测压模式的变化如下（平均值±标准误）：自主收缩从59±6.9 mmHg增至66±7.1 mmHg（P = 0.05），静息张力从33±5 mmHg降至32±4.3 mmHg，直肠感觉从59±5 ml空气增至61±5.2 ml空气（无统计学意义）。5例患者检测出孤立性直肠溃疡综合征。组织学模式显示40%的病例有病理变化。20例大便失禁患者中有6例（30%）症状缓解，9例慢性便秘患者中有4例（44%）症状缓解。3例治疗失败主要与术后脓毒症有关。失禁评分平均改善35%，术后从4.5±0.39降至2.9±0.44（P < 0.01）。总之，德洛姆手术与括约肌成形术联合应用时不会导致便秘，并能改善肛门节制功能。
