摘要
目的探讨一种有效治疗完全性直肠脱垂伴随肛门失禁的外科治疗方法。方法 2000年1月至2009年12月,30例完全性直肠脱垂伴发肛门失禁患者入院后进行肛门指诊、肛门测压(最大静息压MRP和最大收缩压MSP)和排粪造影的评估,30例均进行了直肠悬吊固定和肛提肌折叠术。观察术中的手术时间、出血量、并发症、复发情况及手术前后肛门测压值的变化。结果 30例患者手术均顺利完成,平均手术时间65.5(60～90)min,出血量75(60～100)ml,本组无手术死亡发生,但术后1例切口感染,2例尿潴留,并发症发生率为10%。29例大便失禁改善,术后3个月所有患者MRP和MSP均改善,术前及术后MRP分别为2～30(26.6±2.40)mmHg和2～60(32.5±2.23)mmHg(P=0.007),MSP术前及术后分别为8～152(69.3±6.50)mmHg和35～158(79.5±4.18)mmHg(P=0.001)。平均随访69个月,效果满意,均无复发。结论直肠悬吊固定和肛提肌折叠术不仅治愈了直肠脱垂而且改善了大便失禁,此术式安全有效。
Objective To evaluate a kind of effective treatment of complete rectal prolapse concomitant anal incontinence. Methods From January 2001 to December 2009, 30 patients with rectal prolapse were as- sessed by clinical examination, anal manometry （maximum resting pressure, MRP, and squeeze pressure, MSP） and defecography studies. All patients were treated by sture rectopexy and elevator ani placation. Operative time, hemorrhage volume, morbidity, recurrence rate and the variation of preoperative and postoperative anal manometry were observed. Results Average surgical time was 65.5 （60-90） min and the hemorrhage volume was 75 （60-100） ml, mortality was zero, and morbidity was 10% （one patients with wound infection, two with urinary retention）. Anal incontinence improved in 29 of 30 patients. MRP and MSP had improved at 3 months after surgery： Range of MRP turned 2-30（26.6 ± 2.40）mm Hg before surgery to 2-60（32.5 ± 2.23）mm Hg after surgery （P=0.007）. While MSP from 8-152 （69.3 ± 6.50）mm Hg before surgery to 35-158 （79.5 ± 4.18） mm Hg after surgery （P=0.001）. All the cases suffered from for the complete proetoptosis concomitant anal incontinence in adults were followed up for 69 months averagely. The curative effect was satisfactory with no recurrence. Conclusions The sture rectopexy and levator plication result in an improvement in anal incontinence and satisfactory long-term control of prolapse. The operation are safe and in effect.
出处
《中华普通外科学文献（电子版）》
2011年第4期25-27,共3页
Chinese Archives of General Surgery(Electronic Edition)
关键词
直肠脱垂
悬吊固定术
肛门失禁
外科手术
Rectal prolapse
Rectopexy
Incontinence
Surgical procedures operative
