三联术治疗28例Ⅱ～Ⅲ度完全性直肠脱垂的临床效果分析

Triple surgeries for grade Ⅱ～Ⅲ complete rectal prolapse: a case series of 28 patients

目的观察三联术(直肠瘢痕支持固定术+直肠周围间隙注射术+肛门环缩术)治疗完全性直肠脱垂的临床疗效。方法以2015年2月至2018年2月于中国中医科学院西苑医院肛肠科收治的28例Ⅱ~Ⅲ度完全性直肠脱垂患者为研究对象,患者均采用三联术治疗,观察记录术后1个月疗效、手术时间、术中出血量、术后并发症及其他情况,术后随访观察是否存在复发、大便失禁。结果术后1个月进行疗效评价,28例患者全部治愈。本组患者平均手术时间(52.17±13.21) min,平均术中出血量(26.84±11.33) mL。术后未见大出血、肛门失禁、肠梗阻等并发症发生。术后出现大便次数增多2例,术后黏液血便1例,均经保守治疗后症状消失。术后随访12个月时均达到治愈标准,术后13个月、18个月各有1例复发,再次接受三联术治疗,此2例患者随访至2019年2月无复发、无大便失禁。术后24个月失访1例,失访原因为预留电话停机。结论三联术治疗Ⅱ~Ⅲ度完全性直肠脱垂手术操作简单、疗效确切,术后并发症较少、复发率低。

Objectives To investigate the effect of triple surgeries(supportive fixation of rectal scar, perirectal injection, and anal encirclement) in treating complete rectal prolapse. Methods Twenty-eight patients with grade Ⅱ~Ⅲ complete rectal prolapse treated in Xiyuan Hospital, China Academy of Chinese Medical Sciences, between February 2015 and February 2018 were selected. All patients received triple surgeries. Efficacy after 1 month, duration of surgery, intraoperative blood loss, postoperative complications and other circumstances were recorded. Patients were followed up to record recurrence and incontinence. Results Efficacy was evaluated one month after surgery and all 28 patients were cured. Of all the patients, average operation duration was(52.17±13.21) min and average intraoperative blood loss was(26.84±11.33) mL. No postoperative major bleeding, incontinence, or intestinal obstruction was observed. Two patients had increased bowel movement after surgery and another one had postoperative hematochezia. Symptoms resolved after conservative treatment. All patients remained cured 12 months after surgery. One recurrence occurred at 13 and 18 months, respectively, those two patients received triple surgery again. The last follow-up was conducted in February 2019 and no recurrence or incontinence was observed in the two. There was one patient who lost to follow-up 24 months after surgery due to unreachable phone. Conclusion Triple surgeries was a simple and safe procedure for grade II^III complete rectal prolapse. It had few postoperative complications and low recurrence.