脊髓损伤患者直肠脱垂的手术治疗

Stapled Trans-anal Rectal Resection and Altemeir's Resection for Rectum Prolapse in Spinal Cord Injury Patients

目的评价吻合器经肛门直肠切除术(STARR)或Altemeir术治疗脊髓损伤患者直肠脱垂的疗效。方法对260例脊髓损伤患者进行肛肠疾病调查,21例非手术治疗无效的脊髓损伤直肠脱垂患者根据直肠脱出程度分别使用Altemeir或STARR术进行治疗。采用国际脊髓损伤肠功能基础及扩展数据集了解患者术前、术后12个月排便状况。结果脊髓损伤患者直肠脱垂发生率为32.7%(85/260)。接受手术治疗的21例患者均有不同程度便秘和混合痔,直肠黏膜脱垂(<7 cm)19例,直肠内套叠4例,直肠完全脱垂(7 cm)2例;Ⅰ度13例,Ⅱ度5例,Ⅲ度3例。Ⅰ、Ⅱ度直肠脱垂均使用STARR术治疗,Ⅲ度使用Altemeir手术治疗。术后无严重并发症。术后12个月,患者肠道功能障碍影响生活质量的自我报告明显改善(P<0.01),需偶尔用手掏排便的患者数明显减少(P<0.01);需要外用衬垫或塞子、使用止泻剂的患者显著减少(P<0.001);排便不尽感、腹胀、腹痛/腹部不适缓解(P<0.05)。结论STARR或Altemeir手术是治疗脊髓损伤患者直肠脱垂安全有效的方法。

Objective To investigate the stapled trans-anal rectal resection（STARR） and Altemeir＇s resection for rectum prolapse in spinal cord injury（SCI） patients.Methods Anus bowel disease of 260 SCI patients were investigated,21 cases with rectum prolapse who were invalid for nonoperative treatment chose Altemeir＇s resection or STARR depending on the degree of rectum prolapse.They were recorded according to International Spinal Cord Injury Bowel Function Based and Extension Set before and 12 months after operation.Results 85 SCI patients were with rectum prolapse（32.7%）,21 patients complicated with constipation and mixed hemorrhoid,19 with rectal mucous membrane prolapse（7 cm）,4 with rectal internal mucous intussusception,2 were completely rectum prolapse（7 cm）.Rectum prolapse of Ⅰ degree was found in 13 cases,Ⅱ in 5 cases,and Ⅲ in 3 cases.Patients with Ⅰ or Ⅱ degrees rectum prolapse accepted STARR,those with Ⅲ degrees accepted Altemeir＇s resection.No serious complication was found.Self-report of intestinal dysfunction affecting the quality of life during the 12 months after operation significantly decreased（P0.01）,so as the need of drawing out defecate with hands（P0.01）,the usage of liner,plug,or antidiarrheal（P0.001）.The symptom such as endless defecate feeling,abdominal distension,abdominal pain,abdominal discomfort were significantly alleviated（P0.05）.Conclusion STARR and Altemeir＇s resection are both safe and effective operation for rectum prolapse in SCI patients.