腹腔镜直肠固定术治疗直肠脱垂的选择策略

Selective strategy of laparoscopic rectopexy in the treatment of rectal prolapse

腹腔镜直肠固定术是目前治疗直肠脱垂的一类主流术式,根据直肠的游离程度、固定方法及有无直肠及乙状结肠切除,将术式分为腹腔镜腹侧直肠固定术、腹侧直肠补片固定术、缝合直肠固定术、切除直肠固定术、前侧直肠固定术及后侧直肠固定术。腹腔镜腹侧直肠固定术临床运用最多,已成为治疗直肠脱垂的首选术式。腹腔镜腹侧直肠补片固定术至今还存在一定的争议,尚需进一步研究。腹腔镜缝合直肠固定术可用于儿童直肠脱垂,且效果良好。腹腔镜切除直肠固定术可改善大便失禁,但可能增加便秘的风险。腹腔镜前侧直肠固定术治疗老年和体虚患者,安全有效。腹腔镜后侧直肠固定术存在术后便秘的问题尚待解决。因此,根据患者年龄、身体状况、解剖结构异常和功能紊乱等不同差异的程度,掌握好适应证,选择合适的固定术式进行个体化治疗,极大程度地提高手术效果、减少并发症、降低复发率、改善肠道功能、提高患者满意度。

Laparoscopic rectopexy is one of the main methods to treat rectal prolapse.According to the degree of rectal dissociation,fixation method,the absence of rectum and sigmoidectomy,the surgical methods are divided into laparoscopic ventral rectopexy,laparoscopic ventral mesh rectopexy,laparoscopic suture rectopexy,laparoscopic resection rectopexy,laparoscopic anterior rectopexy and laparoscopic posterior rectopexy.The laparoscopic ventral rectopexy is the most widely used in clinical practice and has become the first choice for the treatment of rectal prolapse.The application of laparoscopic ventral mesh rectopexy is still controversial and needs further study.Laparoscopic suture rectopexy can be used in children with rectal prolapse,and has a good effect.Laparoscopic resection rectopexy can improve fecal incontinence but may increase the risk of constipation.Laparoscopic anterior rectopexy is safe and effective in the treatment of elderly patients and patients with body debility.The problem of postoperative constipation still remains to be solved after laparoscopic posterior rectopexy.Therefore,according to the different degrees of patients′age,physical conditions,anatomical abnormalities,functional disorders and other differences,good indications and appropriate fixation methods for individualized treatment will greatly improve the efficacy of surgery,reduce complications and the recurrence rate,improve the intestinal function and the satisfaction of patients.