CAJ | 학술논문

目的评价一种新的盆底修复直肠悬吊术治疗成人完全性直肠脱垂的临床疗效.方法 2010年1月至2011年5月选择接受盆底修复直肠悬吊术治疗的完全性直肠脱垂患者52例,根据不同手术方式分为两组,A组(n=28)实施腹腔镜盆底修复直肠悬吊术,B组(n=24)实施腹腔镜盆底修复直肠悬吊术联合痔上黏膜环切术.在术前及术后的第6、12、24个月时分别评价两组患者的直肠脱垂程度、便秘程度、大便失禁程度,并对复发例数、并发症进行比较. 结果术后6个月时两组患者直肠脱垂症状消失,随后脱垂症状逐渐加重,而B组在术后第24个月时症状趋于稳定.术后便秘的变化情况与直肠脱垂一致.术后第6个月时两组控便能力均逐步改善并于术后第12个月时恢复最佳,术后第24个月A组控便能力有所减低,B组趋于稳定;术后第24个月时A组有4例复发,B组无复发患者.两组Ⅰ～Ⅲ级并发症比较差异无统计学意义(x2=0.05,P＞0.05).结论腹腔镜盆底修复直肠悬吊术联合痔上黏膜环切术的临床疗效优于腹腔镜盆底修复直肠悬吊术.
목적 평개일충신적분저수복직장현조술치료성인완전성직장탈수적림상료효.방법 2010년1월지2011년5월선택접수분저수복직장현조술치료적완전성직장탈수환자52례,근거불동수술방식분위량조,A조(n=28)실시복강경분저수복직장현조술,B조(n=24)실시복강경분저수복직장현조술연합치상점막배절술.재술전급술후적제6、12、24개월시분별평개량조환자적직장탈수정도、편비정도、대편실금정도,병대복발례수、병발증진행비교. 결과 술후6개월시량조환자직장탈수증상소실,수후탈수증상축점가중,이B조재술후제24개월시증상추우은정.술후편비적변화정황여직장탈수일치.술후제6개월시량조공편능력균축보개선병우술후제12개월시회복최가,술후제24개월A조공편능력유소감저,B조추우은정;술후제24개월시A조유4례복발,B조무복발환자.량조Ⅰ～Ⅲ급병발증비교차이무통계학의의(x2=0.05,P＞0.05).결론 복강경분저수복직장현조술연합치상점막배절술적림상료효우우복강경분저수복직장현조술.
Objective To analyze postoperative effect of a new rectopexy technique with Douglas pouch elevation for complete rectal prolapse (CRP) in adults.Methods From January 2010 to May 2011, 52 CRP cases were treated by rectopexy with Douglas pouch elevation.In terms of different surgical techniques, patients were divided into two groups : Group A (n =28) received laparoscopic rectopexy with Douglas pouch elevation;and Group B (n =24) received laparoscopic rectopexy with Douglas pouch elevation combined with procedure for prolapse and hemorrhoids (PPH).Rectal prolapse, constipation, and fecal incontinence in the two groups were assessed respectively before surgery, and on the 6th, 12th, and 24th month after surgery, postoperative complications were evaluated with severe grading of surgical complications.Results Symptoms of rectal prolapse disappeared at half a year after surgery in all patients, and relapsed to different extent afterwards.However, two years after operation, the status of rectal prolapse in Group B tended to be stable.The trend of constipation after surgery was consistent with that of rectal prolapse.In addition, fecal continence improved gradually on half a year after surgery in the two groups and recovered to the optimal status in the first postoperative year.However, in the second year, the results of fecal incontinence reduced slightly in Groups A, and Group B became stable.Two years after surgery, four cases in Groups A relapsed while there was no recurrence in Group B.Difference of Grade I to Grade Ⅲ complications among the two groups was statistically insignificant (x2 =0.05, P ＞ 0.05).Conclusions The clinical effect of laparoscopic rectopexy with Douglas pouch elevation associated with the procedure for prolapse and hemorrhoids (PPH) is better than that without PPH for female and male CRP patients with severe symptoms.