CAJ | 학술논문

目的：探讨经肛门入路手术方式治疗直肠全层脱垂的疗效。方法直肠全层脱垂38例，28例行经肛门直肠乙状结肠部分切除术（Altemeier术）；8例行经肛门吻合器直肠切除术（STARR术）；2例行改良经肛门吻合器直肠切除术（TST STARR Plus术）。结果切除直肠全层标本长度：Altemeier术8～30 cm，STARR术及TST STARR Plus术4～6 cm。术中并发症：STARR术及TST STARR Plus术各发生吻合器切割后钉合不全1例，给予3-0可吸收线缝合。术后近期并发症：无一例发生吻合口瘘，无一例术后严重早期并发症，2例Altemeier、1例STARR患者术后1周内出现吻合口出血，保守治疗成功。术后平均住院时间为6 d（5～8 d）。中位随访时间38个月（1～47个月），每日排大便次数1～3次，1例患者行Altemeier术后12．5个月复发，1例Altemeier术后吻合口狭窄给予多次扩肛后完全缓解。随访期间所有患者术后性功能未受影响。结论 Altemeier术是治疗＞5 cm的直肠完全脱垂的可靠术式；STARR术和TST STARR Plus术可用于治疗长度＜5 cm的直肠完全脱垂，但STARR术特别是TST STARR Plus术的远期疗效尚需进一步研究证实。
목적：탐토경항문입로수술방식치료직장전층탈수적료효。방법직장전층탈수38례，28례행경항문직장을상결장부분절제술（Altemeier술）；8례행경항문문합기직장절제술（STARR술）；2례행개량경항문문합기직장절제술（TST STARR Plus술）。결과절제직장전층표본장도：Altemeier술8～30 cm，STARR술급TST STARR Plus술4～6 cm。술중병발증：STARR술급TST STARR Plus술각발생문합기절할후정합불전1례，급여3-0가흡수선봉합。술후근기병발증：무일례발생문합구루，무일례술후엄중조기병발증，2례Altemeier、1례STARR환자술후1주내출현문합구출혈，보수치료성공。술후평균주원시간위6 d（5～8 d）。중위수방시간38개월（1～47개월），매일배대편차수1～3차，1례환자행Altemeier술후12．5개월복발，1례Altemeier술후문합구협착급여다차확항후완전완해。수방기간소유환자술후성공능미수영향。결론 Altemeier술시치료＞5 cm적직장완전탈수적가고술식；STARR술화TST STARR Plus술가용우치료장도＜5 cm적직장완전탈수，단STARR술특별시TST STARR Plus술적원기료효상수진일보연구증실。
Objective To investigate the outcomes of transanal approach for complete rectal prolapse.Methods A total of 38 patients received surgical treatment for complete rectal prolapse,including28 patients with transanal rectosigmoidectomy(Altemeier procedure),8 patients with stapled transanalrectal resection(STARR procedure)and 2 patients with TST STARR Plus.Results The length of resected specimens were 8 ~30 cm in the Altemeier procedure and 4 ~6 cm in the STARR or TST STARRPlus.All the specimens were fullthickness rectum.Intraoperative complications included incomplete cutting line after stapling,which occurred in one patient with STARR and one patient with TST STARR Plus.These patients were treated with 30 absorbable sutures.Shortterm postoperative complications such asanastomotic bleeding were observed within the first week,including two patients with Altemeier one patientwith STARR.There were no anastomotic leakage and severe earlystage complications.The average postoperative hospitalization was 6 days(5 ~8 days).After The median followup time was 38 months(1 ~47months)and the frequency of defecation ranged from 1 to 3 times.Recurrence occurred in one patient withAltemeier after 12.5 months.Anastomotic stricture occurred in one patient and then got released after analdilatation.During the followup,sexual function in all patients was normal.Conclusion The Altemeierprocedure is a reliable surgery in treating complete rectal prolapse larger than 5 cm;STARR and TSTSTARR Plus could be used in complete rectal prolapse less than 5 cm.But their longtime curative effect,especially the TST STARR Plus,calls for further study.