腹腔镜直肠悬吊固定术治疗直肠重度脱垂

Treatment for severe rectal prolapse by laparoscopic rectopexy

目的探讨腹腔镜直肠悬吊固定术治疗直肠脱垂的临床应用价值。方法1998年3月至2007年2月,对4例完全性直肠脱垂患者进行了腹腔镜直肠悬吊固定术。1例采用缝合固定法,将直肠后壁分离、提高,用丝线缝闭直肠前陷凹,并将直肠后壁悬吊固定于骶骨岬前筋膜上,再将乙状结肠缝合固定在左侧腰大肌筋膜。3例采用网片固定法,将直肠游离到肛提肌水平,用1张6cm×9cm的T字型聚丙烯网片置于直肠后方,网片下缘在肛提肌水平环绕直肠,在直肠前方用丝线缝合网片和直肠浆肌层,再将网片上端在直肠后用疝修补钉夹固定于骶骨岬前筋膜,缝合关闭盆底腹膜。再将乙状结肠缝合固定在左侧腰大肌筋膜。结果4例患者手术均顺利,无中转开腹者。手术时间92.5（80-100）min,出血量6.5（5～10）ml。无并发症发生。术后尿失禁和肛门失禁的症状缓解,术后随访2个月至3年均未见复发与便秘出现。结论腹腔镜下行腹腔镜直肠悬吊固定术创伤小、恢复快和安全有效。

Objective To evaluate the clinical practice of laparoscopic rectopexy in the treatment of severe rectal prolapse. Methods From March 1998 to February 2007, 4 cases of complete rectal prolapse, including 1 male and 3 female,ranged 21-82 years old, were treated by laparoscopic rectopexy. In one case, the posterior wall of rectum was freed and elevated, and pre-rectal introcession was closed by silk suture, then the posterior wall was suspended and fixed on sacral promontory fascia, finally the sigmoid colon was fixed by sutures on the fascia of left psoas major. In other three cases, insertion of mesh was performed. Rectum was freed and elevated to the level of levalor ani. A sheet of T-shape polypropylene mesh was placed posterior to the rectum, whose lower margin was at the level of levator ani and wrapped around the rectum covering except the anterior wall. The free margin of the mesh was sutured on the muscular layer of rectum, then the mesh was put posterior to the rectum and fixed on the sacral promontory fascia by clipping to repair hernia. After that, the pelvic peritoneum was closed, and finally the sigmoid colon was fixed by sutures on the fascia of left psoas major. Results Four operation procedures were completed successfully. There was no conversion operation. The time was consumed 92.5 （80-100） min, and the bleeding amount was 6.5（5-10） ml. No post-operative complications were found. Urine incontinence and encopresis were relieved. No recurrence and constipation was found after 2 months to 3 years follow up postoperatively. Conclusion Laparoscopic rectopexy is a safe, workable and effective procedure, which can reduce operative trauma and shorten hospitalization time.