腹腔镜直肠缝线固定术：一种治疗完全性直肠脱垂的简便有效术式

Laparoscopic suture rectopexy :a simple and effective procedure for complete rectal prolapse

目的探讨腹腔镜直肠缝线固定术治疗完全性直肠脱垂的临床效果。方法对我院2010年1月至2014年1月采用腹腔镜直肠缝线固定术治疗的36例完全性直肠脱垂病例进行观察,并与同期采用腹腔镜直肠补片固定术治疗的16例同病种病例进行对照。结果采用直肠缝线固定术的平均手术时间明显短于直肠补片固定术(110±13 min vs 120±9 min,P<0.05),而且住院费用也较低(16227±845元vs 19143±1163元,P<0.05)。两组在平均术中出血量、平均术后肛门恢复排气时间、平均术后住院时间方面相比均无统计学差异。两组患者均无术后早期并发症。中位随访时间26个月,两组患者在术后1月和术后1年的直肠脱垂复发率、Wexner便秘评分、胃肠生活质量指标GIQLI均无显著性差异(P>0.05)。结论腹腔镜直肠缝线固定术对治疗完全性直肠脱垂具有手术创伤小、恢复快、住院时间短、费用低等优点,而近期和远期随访均具有满意的效果。

Objective To investigate the clinical effect of laparoscopic suture rectopexy for the treatment of complete rectal prolapse in adults. Methods A total of 52 patients with complete rectal prolapse from January 2010 to January 2014 were included in this study, in which 36 cases （Group A） underwent surgical treatment by using ]aparoscopic suture rectopexy procedure, 16 （Group B） in the same period underwent laparoscopic mesh rectopexy. The clinical efficacy was observed in all patients and compared between two groups. Results The average operation time was 110±13 min in Group A and 120±-9 min in Group B, in which there was significant difference （P〈0.05）. There was no significant difference between two groups about the average intraoperative bleeding （30±10 ml vs 34±9 ml）, the average postoperative anal exhaust time （35±8 h vs 39±9 h）, the average postoperative hospitalization time （5.1 ± 1.3 d vs 5.8 ± 1.2 d） （all, P〉0.05 ）. The average treatment cost was RMB 16227±845 yuan in Group A and RMB 19143±1163 yuan in Group B, and there was significant difference between two groups （P〈0.05）. There were no early complications found in both groups. The median follow-up time was 26 months. There was no significant difference between the two groups about the rectal prolapse recurrence rate, Wexner constipation score and gastrointestinal quality of life index （GIQLI） of one month or one year after operation （P〉0.05）. Conclusion Laparoscopic suture rectopexy for complete rectal prolapse had such advantages as minor surgical trauma, quicker recovery, shorter hospitalization time, lower cost, and showed satisfactory results in short and long term follow-up.