经会阴直肠乙状结肠切除术治疗直肠脱垂的中短期疗效观察

Short and Mid-Term Efficacy of Altemeier Procedure in the Treatment of Rectal Prolapse

目的分析经会阴直肠乙状结肠切除术(Altemeier术)治疗直肠脱垂的中短期临床疗效。方法回顾性分析2015年1月～2017年9月在湖南省人民医院(湖南师范大学第一附属医院)肛肠外科行Altemeier术的15例直肠脱垂患者的临床和随访资料。结果 15例患者均顺利完成手术,一期出院,无一例围手术期死亡。手术时间为135(90～160) min,术中失血量为50(30～100) ml,手术切除肠管长度6～18 cm。术后住院时间为8. 3(7～16) d。其中5例急性嵌顿患者中2例手法复位成功后行择期手术,其余行急诊手术。1例(6. 7%)术后出现吻合口出血。术后随访6～39个月(平均16. 7个月),随访期内无复发。术后6月,Wexner便秘评分和Wexner失禁评分均较术前显著降低(P <0. 05)。结论 Altemeier术治疗直肠脱垂的安全有效,并发症少,短期复发率低。

Objective To analyze the efficacy of the perineal rectosigmoidectomy(Altemeier procedure)in the treatment of rectal prolapse. Method From January 2015 to September 2017,a retrospective analysis was carried out in 15 patients with rectal prolapse undergoing Altemeier procedure. Results All the procedures were success and there was no perioperative death.Operation time was 135(90~160)minutes,and the blood loss was 50(30~100)ml.The length of the resected rectum was 6~18 cm.The post-operative hospital stay was 8.3(7~16)days.Of the 5 patients with acute incarceration,there were 2 cases underwent selective operation after successful manual reduction,and the rest 3 cases underwent emergency operation.There was only one patient(6.7%)suffered from anastomotic bleeding.No recurrence was found in 6 to 39 months follow-up.Wexner constipation score and Wexner fecal score were significantly reduced after operation(P<0.05).Conclusion Altemeier procedure is a safe operation in the treatment of rectal prolapse,with few complication and low recurrence.