Altemeier手术在嵌顿性直肠脱垂急诊处理中的应用

Application of Altemeier procedure in the emergent management of acute incarcerated rectal prolapse

目的 评价Altemeier手术在嵌顿性直肠脱垂急诊处理中的应用价值.方法 回顾性分析经Altemeier手术急诊治疗的9例嵌顿性直肠脱垂患者的临床资料.结果本组9例患者均行经会阴直肠乙状结肠部分切除术,手术时间1.0～1.5（平均1.7）h,术中失血50～200（平均109）ml,术后首次排便时间1～6（平均2.8）d,总住院时间3～10（平均5.3）d.术后无吻合口瘘、腹腔感染、泌尿生殖功能障碍等并发症发生,1例患者术后直肠系膜血栓形成,1例患者出现肛门不适症状.术后经5个月至6.5年（平均3.5年）的随访,所有患者未出现再次脱垂.术后6个月肛门功能Kirwan Ⅰ级8例,Ⅱ级1例;所有患者均感到满意.结论 Altemeier手术治疗嵌顿性直肠脱垂术后肛门功能良好,可作为嵌顿性直肠脱垂急诊处理的首选术式之一.

Objective To evaluate the perineal rectosigmoidectomy（Altemeier procedure） in the emergent management of acute incarcerated rectal prolapse. Methods Clinical and follow-up data of 9 patients with acute incarcerated rectal prolapse undergone Altemeier procedure were retrospectively analyzed. Results The mean operation time was 1.7 （range 1.0-1.5） hours. The mean total blood loss during surgery was 109 （50-200） ml. The mean time to the first bowel movements was 2.8（1-6） days after surgery. The hospital stay was 5.3 （3-10） days. There were no postoperative complications such as anastomotic leakage, intra-abdominal infection, or urogenital dysfunction. One patient developed thrombosis in the mesorectum and one patient had symptoms of anal discomfort. After a mean follow-up of 3.5 （5 months-6.5 years） years, no patient had recurrent prolapse. Six months after operation, anal function was Kirwan grade Ⅰ in 8 cases and grade Ⅱ in 1 case. All the patients were satisfied with the result. Conclusion Altemeier procedure can result in good postoperative anal function when treating incarcerated rectal prolapse, which shonld be the first choice in emergency treatment.