CAJ | 학술논문

目的探讨Delorme手术在直肠脱垂治疗中的应用.方法回顾性分析2005年3月至2010年6月间4家医院收治的25例行Delorme手术的完全性直肠脱垂患者的临床资料.结果 25例患者中男性9例,女性16例,年龄46～72(平均52)岁.均顺利完成Delorme手术,无围手术期死亡病例.手术时间45～150(平均65)min,术中出血20～200(平均58)ml,住院时间5～14(平均8.5)d.术后7d,1例患者出现吻合口裂开出血,珠网膜下腔麻醉下再次止血缝合;术后发生轻微并发症8例次,1例顽固性疼痛,3例尿潴留,4例粪便嵌塞.随访时间2～6(平均3.5)年,期间复发1例.术后仍有粪便失禁、便秘和出血的比例分别为37.5％(6/16)、45.5％(5/11)和15.4％(2/11),Wexner失禁评分明显降低(中位数5.0比9.0,P＜0.01).肛门静息压和最大压榨压较术前明显增加,初始感觉容积和最大耐受容积较术前明显减少(均P＜0.01).结论 Delorme手术安全、易操作,术后肛门直肠功能明显改善,可考虑作为直肠脱垂的首选方法.
목적 탐토Delorme수술재직장탈수치료중적응용.방법 회고성분석2005년3월지2010년6월간4가의원수치적25례행Delorme수술적완전성직장탈수환자적림상자료.결과 25례환자중남성9례,녀성16례,년령46～72(평균52)세.균순리완성Delorme수술,무위수술기사망병례.수술시간45～150(평균65)min,술중출혈20～200(평균58)ml,주원시간5～14(평균8.5)d.술후7d,1례환자출현문합구렬개출혈,주망막하강마취하재차지혈봉합;술후발생경미병발증8례차,1례완고성동통,3례뇨저류,4례분편감새.수방시간2～6(평균3.5)년,기간복발1례.술후잉유분편실금、편비화출혈적비례분별위37.5％(6/16)、45.5％(5/11)화15.4％(2/11),Wexner실금평분명현강저(중위수5.0비9.0,P＜0.01).항문정식압화최대압자압교술전명현증가,초시감각용적화최대내수용적교술전명현감소(균P＜0.01).결론 Delorme수술안전、역조작,술후항문직장공능명현개선,가고필작위직장탈수적수선방법.
Objective To evaluate the use of Delorme procedure for full-thickness rectal prolapse.Methods A series of 25 patients with full-thickness rectal prolapse were treated by Delorme procedure in four institutions between March 2005 and June 2010.The clinicopathological data were analyzed retros retrospectively pectively.Results There were 9 males and 16 females.The mean age was 52 (46-72) years old.All the procedures were successfully performed.There were no perioperative deaths.The mean operative time was 65 (45-150) min.The intraoperative bleeding was 58 (20-200) ml.The mean length of hospital stay was 8.5 (5-14) days.Anastomosis dehiscence occurred in 1 patient at post-operative day 7 who was managed under anesthesia.Minor complications occurred in 8 (32％) patients,including urinary retention (n=3),intractable pain (n=1),and bowel obstruction (n=4).The follow up time ranged from 2 to 6 years with a median of 3.5 years.Prolapse recurrence was observed in 1 (4％) patient during the follow up.The remission rates of fecal incontinence, constipation, bleeding were 37.5％ (6/16), 45.5％ (5/11), and 15.4％ (2/11),respectively.The Wexner incontinence score significantly decreased (median,5.0 vs.9.0,P＜0.01).The resting pressure and maximum squeeze pressure increased significantly after surgery,while the initial volume and maximal tolerance volume decreased significantly (All P＜0.01).Conclusions Delorme procedure is safe and easy to perform.The anorectal function is improved after surgery.Therefore it should be considered the procedure of choice for rectal prolapsed.