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首页> 外文期刊>Surgical Endoscopy >Laparoscopic rectopexy for full-thickness rectal prolapse: a single-institution retrospective study evaluating surgical outcome.
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Laparoscopic rectopexy for full-thickness rectal prolapse: a single-institution retrospective study evaluating surgical outcome.

机译：腹腔镜直肠切除术治疗全层直肠脱垂：评估手术结果的单机构回顾性研究。

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BACKGROUND: The laparoscopic approach promises to become the gold standard for the transabdominal management of full-thickness rectal prolapse. The aim of this study was to review our experience and to highlight the functional results achieved with this new technique. METHODS: Forty-eight patients with full-thickness external prolapse underwent laparoscopic repair between February 1997 and February 2003. All patients underwent preoperative evaluation of their rectal function. Patients with isolated rectal ulcer without prolapse or with internal prolapse and patients deemed by the anesthesiologist to be unfit for general anesthesia were excluded from the study. The laparoscopic technique was either a mesh rectopexy without resection (n = 35) or a suture rectopexy with sigmoid resection (n = 13). Patients with intractable constipation preceding the development of the rectal prolapse were advised to have a resection-rectopexy. In the postoperative follow-up, attention was paid to mortality, morbidity, recurrent prolapse, incontinence, and constipation. Follow-up was done by clinical review and postal questionnaire. RESULTS: There were no deaths and no septic or anastomotic complications. The postoperative morbidity rate was 5%. Oral intake was started on postoperative day 1. Discharge from the hospital was on postoperative day 4 in patients without sigmoid resection and on postoperative day 7 in patients with sigmoid resection. Two patients (4%) developed recurrent total prolapse during a median follow-up period of 36 +/- 15 months (range, 7-77). The functional results were good or excellent in 72% of the cases, without digitations or dyschesia. Continence was improved in 31% of the patients and remains unchanged in 64% of them. In 11 patients (23%), constipation was worsened by the procedure. CONCLUSION: Laparoscopic rectopexy with or without resection is both safe and effective. Advantages include low-morbidity, improved cosmesis, the rapid return of intestinal function, early discharge from hospital, and a low recurrence rate. The fecal continence score is improved; however, constipation is frequently worsened.
机译：背景：腹腔镜手术有望成为全厚度直肠脱垂经腹处理的金标准。这项研究的目的是回顾我们的经验，并强调通过这项新技术获得的功能结果。方法：1997年2月至2003年2月间，对48例全层外脱垂患者进行了腹腔镜修复。所有患者均接受了直肠功能的术前评估。患有单纯性直肠溃疡但没有脱垂或内部脱垂的患者，以及被麻醉医师认为不适合全身麻醉的患者被排除在研究范围之外。腹腔镜技术要么是不切除的网状直肠切除术（n = 35），要么是乙状结肠切除的缝合线切除术（n = 13）。建议在直肠脱垂之前患有顽固性便秘的患者进行直肠切除术。在术后随访中，要注意死亡率，发病率，复发脱垂，大小便失禁和便秘。通过临床检查和邮政调查表进行随访。结果：无死亡，无败血症或吻合口并发症。术后发病率为5％。术后第1天开始口服摄入。对于没有乙状结肠切除术的患者，在术后第4天出院，对于乙状结肠切除术的患者在术后第7天出院。两名患者（4％）在中位随访期36 +/- 15个月（范围7-77）内出现了复发性总脱垂。在72％的病例中，其功能性结果良好或优异，无手指或听觉障碍。 31％的患者的节制性得到改善，其中64％的患者保持不变。在该过程中，有11名患者（23％）的便秘恶化。结论腹腔镜直肠癌伴或不伴切除术都是安全有效的。优点包括发病率低，美容效果好，肠功能快速恢复，出院早以及复发率低。大便失禁评分得到改善;但是，便秘经常恶化。

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