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中华结直肠疾病电子杂志 ›› 2022, Vol. 11 ›› Issue (05) : 384 -391. doi: 10.3877/cma.j.issn.2095-3224.2022.05.006

论著

经腹与经会阴不同术式对直肠内脱垂手术的疗效分析
王李1, 李凡1, 李春穴1, 张安平1, 刘宝华1, 童卫东1,()   
  1. 1. 400038 重庆,陆军军医大学大坪医院(陆军特色医学中心)胃结直肠外科
  • 收稿日期:2021-12-22 出版日期:2022-10-25
  • 通信作者: 童卫东
  • 基金资助:
    国家自然科学基金面上项目(81770541); 重庆市技术创新与应用发展项目(cstc2019jscx-msxmX0227)

Outcomes of different transabdominal and transperineal surgical procedures for internal rectal prolapse

Li Wang1, Fan Li1, Chunxue Li1, Anping Zhang1, Baohua Liu1, Weidong Tong1,()   

  1. 1. Department of Gastric & Colorectal Surgery, Daping Hospital, Army Medical University, Chongqing 400038, China
  • Received:2021-12-22 Published:2022-10-25
  • Corresponding author: Weidong Tong
引用本文:

王李, 李凡, 李春穴, 张安平, 刘宝华, 童卫东. 经腹与经会阴不同术式对直肠内脱垂手术的疗效分析[J/OL]. 中华结直肠疾病电子杂志, 2022, 11(05): 384-391.

Li Wang, Fan Li, Chunxue Li, Anping Zhang, Baohua Liu, Weidong Tong. Outcomes of different transabdominal and transperineal surgical procedures for internal rectal prolapse[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2022, 11(05): 384-391.

目的

直肠内脱垂(IRP)是引起排便功能障碍的常见原因。当非手术治疗无效且症状逐渐加重,严重影响生活质量时,需要考虑外科手术治疗。但目前IRP手术方式繁多,疗效报道不一。本文将探讨经腹与经会阴不同手术方式对IRP手术的疗效。

方法

采用回顾性队列研究方法。选取陆军军医大学大坪医院2000年1月至2018年12月期间诊断为IRP并符合ODS的便秘手术患者,收集并回顾性分析所有手术患者的临床资料及随访结果。所有患者被分为经腹手术组(n=69)和经会阴手术组(n=101),其中经腹手术组又分为经腹直肠固定术组(n=28)和经腹直肠固定+乙状结肠切除术组(n=41)。评价指标:围手术期相关指标(包括手术操作时间、术中出血量、术后患者住院天数、患者住院费用以及术后并发症等)和功能性指标(便秘症状及生活质量改善情况)。分析比较不同手术方式的临床结局和疗效。

结果

经腹手术组患者在手术时间、出血量、术后住院天数及住院费用方面要高于经会阴手术组(t=3.124,1.497,0.524,1.765;P<0.001)。两组患者在术后早期并发症比较差异无统计学意义(χ2=0.141,P>0.05),而在术后晚期并发症比较,经腹手术组要高于经会阴手术组(χ2=6.844,P=0.009)。经会阴手术组术后复发率高于经腹手术组(χ2=4.777,P=0.029)。两组患者手术后Wexner便秘评分均显著降低(t=22.126,31.324;P<0.001)。经腹直肠固定术组在手术时间、出血量、术后住院天数及住院费用方面要低于经腹直肠固定+乙状结肠切除术组(t=1.782,0.926,0.421,3.41;P<0.05)。两组患者术后早期及晚期并发症、复发率比较均差异无统计学意义(χ2=0.129,0.333,0.885;P>0.05)。两组患者手术后Wexner便秘评分、主观有效性及满意度评价比较均差异无统计学意义(t=-0.386,χ2=0.430;P>0.05)。

结论

经腹与经会阴手术治疗IRP患者均可以取得较好的术后疗效。经腹手术入路有更好的便秘缓解率及更低的复发率,而经会阴手术对特定人群仍然具有较低并发症率、更好的卫生经济学优势等优点。额外增加乙状结肠切除术并不能增加经腹手术的疗效。

Objective

Internal rectal prolapse (IRP) is a common disease causing defecation disorder. Surgical treatment should be considered when non-surgical treatment is ineffective, the symptoms are gradually aggravated, and the quality of life is impaired. However, there are many operative methods and different postoperative outcomes for IRP. This paper will discuss the effect of different surgical procedures of transabdominal and transperineal for IRP.

Methods

A retrospective cohort study was used. Patients with constipation who were diagnosed with IRP and met ODS in Daping Hospital, Army Medical University from January 2000 to December 2018 were selected, and the clinical data and follow-up results of all patients were collected and analyzed retrospectively. All patients were divided into transabdominal procedure group (n=69) and transperineal procedure group (n=101). The transabdominal procedure group was divided into transabdominal rectopexy group (n=28) and transabdominal rectopexy + sigmoidectomy group (n=41). Evaluation indexes: perioperative related indexes (including operation time, intraoperative bleeding, postoperative hospitalization days, hospitalization expenses and postoperative complications) and functional indexes (improvement of constipation symptoms and quality of life). The clinical outcomes and effect of different surgical procedures were analyzed and compared.

Results

The operation time, blood loss, postoperative hospitalization days and hospitalization expenses in the transabdominal procedure group were higher than those in the transperineal procedure group (t=3.124, 1.497, 0.524, 1.765; P<0.001). There was no significant difference in early postoperative complications between the two groups (χ2=0.141, P>0.05), but the late postoperative complications in the transabdominal procedure group were higher than those in the transperineal procedure group (χ2=0.844, P=0.009). The postoperative recurrence rate of transperineal operation group was higher than that of abdominal operation group (χ2=4.777, P=0.029). The Wexner constipation scores after surgery were lower in both groups (t=22.126, 31.324; P<0.001). The operation time, bleeding volume, postoperative hospitalization days and hospitalization expenses in the transabdominal rectopexy group were lower than those in the transabdominal rectopexy + sigmoidectomy group (t=1.782, 0.926, 0.421, 3.41; P<0.05). There was no significant difference in early and late postoperative complications, recurrence rate between the two groups (χ2=0.129, 0.333, 0.885; P>0.05). There was no significant difference in postoperative Wexner constipation score, subjective effectiveness and satisfaction in the two groups (t=-0.386, χ2=0.430; P>0.05).

Conclusion

Both transabdominal and transperineal surgery can achieve better postoperative efficacy in the treatment of IRP. Transabdominal approach has better constipation remission and lower recurrence rate, while transperineal surgery still has the advantages of lower complication rate and better health economics. Additional sigmoidectomy did not improve constipation and postoperative outcomes in the transabdominal surgery.

表1 两组手术患者的临床资料比较(
xˉ
±s,例)
表2 经腹两种不同手术方式患者的临床资料比较(
xˉ
±s,例)
表3 两组手术患者的临床结局(
xˉ
±s,例)
表4 经腹两种不同手术组比较(
xˉ
±s,例)
表5 两组患者手术前后Wexner便秘评分结果(
xˉ
±s,分)
图1 两组患者手术前后Wexner便秘评分比较 注:*P<0.001:组内比较;
表6 经腹两种不同手术方式手术前后Wexner便秘评分比较(
xˉ
±s,分)
图2 经腹两种不同手术方式手术前后Wexner便秘评分比较 注:*P<0.001:组内比较;#P>0.05:组间比较
表7 两组患者术后有效率及满意度比较
表8 经腹手术组两种不同手术方式有效率及满意度比较(例)
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