回顾性分析经腹与经会阴手术治疗完全性直肠脱垂104例

Comparison of transabdominal and transperineal procedures for complete rectal prolapse: Analysis of 104 cases

目的:探讨比较经腹与经会阴手术治疗完全性直肠脱垂的临床效果.方法:选取1995-03/2014-05在新乡市中心医院肛肠科住院治疗的完全性直肠脱垂患者104例,患者被分为经腹手术组(n=64)和经会阴手术组(n=40).对两组患者术后相关指标进行观察,并进行统计学分析.结果:在经腹手术组中,年轻男性患者多于经会阴手术组.经腹手术组手术时间和(165min±67 min vs 70 min±38 min,P<0.001)住院时间(10 d±4 d vs 7 d±2 d,P<0.001)高于经会阴手术组,但经腹手术组总复发率低于经会阴手术组(6.3%vs 15.0%,P<0.05).两组患者并发症总发生率相近(10.9%vs 6.8%,P>0.05).在经腹手术组中,患者术后出现便秘的情况较多见,而在经会阴手术组中,患者术后出现大便失禁的情况则更多见.结论:两种手术方式术后并发症发生率相近.但在复发率方面,经会阴手术组高于经腹手术组.外科医师术前应仔细评估患者病情,选择合适的手术方法来治疗完全性直肠脱垂.

AIM：To evaluate and compare the clinical outcomes of transabdominal and transperineal surgical procedures for patients with complete rectal prolapse.METHODS：A retrospective study was performed of patients with complete rectal prolapse who received surgical treatment at the Central Hospital of Xinxiang between March 1995 and May 2014.Patients were classified according to the type of operation：transabdominal procedure（n = 64） and transperineal procedure（n = 40）.Clinical effects were compared for the two groups.RESULTS：There were more young patients and males in the transabdominal group than in the transperineal group.Compared with the transperineal group,the transabdominal group had longer operating time（165 min ± 67 min vs 70 min ± 38 min,P 〈 0.001）,longer hospital stay（10d ±4 d vs 7 d± 2d,P〈 0.001）,but a lower overall recurrence rate（6.3%vs 15.0%,P〈 0.05）.The overall rate of complications was similar between the two groups（10.9%vs 6.8%,P 〉 0.05）.The patients in the transabdominal group complained more frequently of constipation than of incontinence,conversely,in the transperineal group of incontinence than of constipation.CONCLUSION：The two approaches for treating complete rectal prolapse did not differ with regard to postoperative morbidity,but recurrence occurs frequently among patients in the transperineal group.Surgeons should carefully assess the condition of patients before operation and select the appropriate surgical approach for treating complete rectal prolapse.