腹腔镜改良直肠前切除治疗老年直肠脱垂的疗效

Modified laparoscopic anterior resection of the rectum for rectal prolapse in elderly patients

目的:探讨采用腹腔镜改良直肠前切除治疗老年直肠脱垂的可行性、安全性和临床疗效.方法:收集2005-01/2013-12收治的确诊为直肠脱垂的老年患者,腹腔镜手术组20例和开腹手术组20例,对其临床资料进行比较分析.结果:两组患者均获得成功,手术切除标本平均长度21.7 cm±2.2 cm和22.3 cm±2.1 cm,差异无统计学意义(P>0.05).平均出血量118.0 mL±40.8 mL和156.0 mL±33.5 mL,肠道功能恢复时间2.3 d±0.9 d和3.9 d±0.7 d,术后平均住院时间6.3 d±1.1d和9.9 d±1.7 d,两组平均手术时间146.0 min±22.3 min和115.0 min±16.5 min,差异有统计学意义(P<0.05).并发症发生率分别为15%和45%,腹腔镜手术组术后并发症发生率低,与开腹手术组比较差异有统计学意义(P<0.05).术后平均随访36.0 mo±11.3 mo,两组复发率差异无统计学意义(P>0.05).结论:采用腹腔镜改良直肠前切除术治疗老年直肠脱垂安全、可靠,具有明显的微创优势,临床疗效比较满意.

AIM： To assess the clinical effects, feasibility and safety of modified laparoscopic anterior resection of the rectum for rectal prolapse in elderly patients. METHODS： The clinical data for 20 elderly patients suffering from rectal prolapse who underwent modified laparoscopic anterior resection of the rectum（laparoscopic group） and 20 elderly patients who under went modified anterior resection of the rectum（open group） from 2005 to 2013 were collected. Comparative analysis of the two surgical groups was done. RESULTS： Surgery was successful in all of the 40 cases. The mean length of the resected specimen was 21.7 cm ± 2.2 cm vs 22.3 cm ± 2.1 cm and showed no significant difference between the two groups. Mean intraoperative blood loss（118.0 m L ± 40.8 m L vs 156.0 m L ± 33.5 mL）, time to recovery of intestinal function（2.3 d ± 0.9 d vs 3.9 d ± 0.7 d）, mean duration of postoperative hospital stay（6.3 d ± 1.1 d vs 9.9 d ± 1.7 d） and mean operational time（146.0 min ± 22.3 min vs 115.0 min ± 16.5 min） differed significantly between the two groups. There was also a significant difference between the two groups in the rate of complications（15% vs 45%）. All the cases were followed for 36.0 mo ± 11.3 mo and the recurrence rate was 10.0% vs 5.0%, showing no significant difference between the two groups.CONCLUSION ： Modified laparoscopic anterior resection of the rectum for rectal prolapse in elderly patients is safe, effective, and satisfactory, with low recurrence rate and minimal invasiveness. Laparoscopic procedure should be considered first for rectal prolapse in elderly patients.