改良经会阴直肠脱垂吻合器切除术治疗完全性直肠脱垂的手术技巧

Application of Modified Perineal Stapled Prolapse Resection in Treatment of External Rectal Prolapse

目的 总结改良经会阴直肠脱垂吻合器切除术（perineal stapled prolapse resection，PSP）治疗完全性直肠脱垂的手术技巧经验，并初步评价手术的疗效。方法 回顾性分析2013年12月至2015年8月期间于广州中医药大学第一附属医院肛肠科接受改良PSP术的11例完全性直肠脱垂患者的临床资料。结果 所有患者均在静吸复合全麻和（或）硬膜外麻醉下完成改良PSP术。手术时间为40～85 min、（53.6±6.1） min；术中出血量为20～60 mL、（35.3±10.1） mL；所有患者均在术后24 h内恢复排气，首次排便时间为术后40～52 h、（44.6±3.3） h；住院时间为7～12 d、（9.7±1.8） d；住院费用为31 796～36 212元、（34 635.8±1 268.8）元。术后围手术期间均无吻合口大出血、吻合口漏、盆腔脓肿、肠梗阻、吻合口狭窄等并发症发生。术后所有患者均获访，随访时间为3～7个月、（4.7±0.8）个月，随访期间无直肠脱垂复发和肛门失禁病例。结论 对于经济条件允许的完全性直肠脱垂患者，改良PSP术是一种安全有效的治疗方法，其手术关键技巧在于同时切开3点和9点的脱垂直肠壁，并在使用弧形切割吻合器之前修剪直肠系膜。

Objective To evaluate the application of modified perineal stapled prolapse resection in treatment of external rectal prolapse, and to assess the preliminary efficacy. Methods Clinical data of 11 patients with external rectal prolapse underwent modified perineal stapled prolapse resection in The First Affiliated Hospital of Guangzhou University of Chinese Medicine between December 2013 and August 2015 were collected for retrospectively analysis. Results All patients with external rectal prolapse were performed modified perineal stapled prolapse resection with general anesthesia and （or） epidural anesthesia. The average operation time was （53.6±6.1） min （40-85 min） and the average blood loss was （35.3±10.1） mL （20-60 mL）. The time of the first flatus was less than 24 h after operation, the time of the first defecation was （44.6±3.3） h （40-52 h） after operation. The average hospital stay was （9.7±1.8） d （7-12 d） and average cost was （34 635.8±1 268.8） RMB （31 796-36 212 RMB）. None of them occurred serious complications such as uncontrollable anastomotic stoma bleeding, anastomotic leakage, pelvic abscess, bowel obstruction, and anastomotic straitness. All of the 11 patients were followed up for （4.7±0.8） months （3-7 months）, and all patients did not suffered from recurrence and fecal incontinence during follow-up period. Conclusions The essential procedure for modified perineal stapled prolapse resection is cutting the prolapse open at 3 and 9 clock directly at the same time by linear staplers, and dissecting mesorectum before using the contour satpler. Modified perineal stapled prolapse resection is a safe and effective operation technique for the external rectal prolapse.