Gant-Miwa联合肛门环缩及消痔灵注射术治疗直肠全层脱垂的手术技巧(附16例报告)

Surgical techniques of Gant-Miwa and anal encircling procedure with Xiaozhiling injection for the treatment of complete rectal prolapse

目的总结Gant-Miwa联合肛门环缩及消痔灵注射术(以下简称三联术)治疗直肠全层脱垂的手术操作细节关键点与手术技巧,以提升该术式的疗效及预防并发症。方法总结沈阳军区总医院于2011年2月至2015年2月采用三联术治疗直肠全层脱垂的16例患者手术过程中的操作技巧、操作要点及相关注意点,提高手术疗效及减少术后并发症。结果 16例患者均手术顺利,术后脱垂症状消失,3例出现尿潴留,2例出现肛周术区感染而复发,1例肛周切口延迟愈合,2例出现直肠狭窄致便秘,无大出血、肛周脓肿、肛瘘等并发症,无围手术期死亡病例。术后13例患者接受了平均2.2年的随访,2例直肠脱垂复发。结论三联术是经会阴入路治疗直肠脱垂的主要手术方式之一,经过在关键步骤及细节方面的创新与改良,可以进一步提高术后疗效及预防并发症的发生,使之成为治疗直肠全层脱垂的一种疗效更为可靠而且并发症更少的方法。

Objective To summarize the operation details and skills of Gant-Miwa and anal encircling procedure with Xiaozhiling injection for the treatment of complete rectal prolapse,and to enhance the postoperative effect as well as prevent the complications.Methods The operation technique,key points and relevant attention points of the procedure for the treatment of 16 patients with complete rectal prolapse in the Genaral Hospital of Shenyang Military Command between February 2011 and February 2015 were summarized to improve the postoperative effect and reduce the complications.Results ：The operations were smoothly performed in all 16 patients and prolapse symptoms disappeared after operation.There was no bleeding,perianal abscess,anal fistula,other complications and perioperative deaths.While three patients with urinary retention,two patients with recurrence result from infection in perianal area,one patient with delayed healing of perianal incision,and two patients with constipation caused by rectal stenosis.Thirteen patients had 2.2years of follow-up,with 2patients of recurrence.Conclusion The procedure is one of the methods for the treatment of complete rectal prolapse via the perineal approach,and it can further improve the postoperative effect and prevent the complications after innovation and improvement in the key steps and details.Therefore,it can be a method with more reliable effect and less complication for the complete rectal prolapse.