腹腔镜盆底修复直肠悬吊联合痔上黏膜环切吻合术治疗完全性直肠脱垂的疗效分析

Effect of laparoscopic rectopexy with Douglas pouch repair and the procedure for prolapse and hemorrhoids for complete rectal prolapse

目的探讨腹腔镜盆底修复直肠悬吊联合痔上黏膜环切吻合术治疗完全性直肠脱垂的疗效.方法回顾性分析2014年10月至2017年6月在解放军第九八九医院接受腹腔镜盆底修复直肠悬吊联合痔上黏膜环切吻合术治疗的36例完全性直肠脱垂患者的临床资料.结果本组36例患者手术顺利,术后1例出现左肾积水,均未出现腹腔感染、大出血等并发症,无围手术期死亡患者.术后2例患者出现复发.术后第12个月便秘评分和便失禁评分与术前比较差异均有统计学意义[(5.97±1.36)比(10.92±1.96),t=17.39,P<0.05;(6.28±1.49)比(10.81±2.16),t=16.32,P<0.05];术后第24个月便秘评分和便失禁评分与术前比较差异均有统计学意义[(5.81±1.28)比(10.92±1.96),t=15.36,P<0.05;(6.03±1.67)比(10.81±2.16),t=14.64,P<0.05];术后第12个月与第24个月便秘评分和便失禁评分比较差异均无统计学意义(t=0.85、1.12,均P>0.05).结论腹腔镜盆底修复直肠悬吊联合痔上黏膜环切吻合术是治疗完全性直肠脱垂的有效术式.

Objective To evaluate treatment of laparoscopic rectopexy with Douglas pouch repair plus the procedure for prolapse and hemorrhoids(PPH)for complete rectal prolapse(CRP).Methods A total of 36 CRP patients treated by laparoscopic rectopexy associated with the procedure for PPH at No.989 Hospital of PLA between Oct 2014 and June 2017 were retrospectively analyzed.Results Operations were successful in all these 36 cases.One patient developed left post-op hydronephrosis and no other major complications were observed,such as intra-abdominal hemorrhage,infection.2 of 36 patients developed recurrent prolapse.The constipation score and incontinence score at the 12th month after operation were significantly different from those before operation[(5.97±1.36)t;s.(10.92±1.96),t=17.39,P<0.05;(6.28±1.49)vs.(10.81±2.16)=16.32,P<0.05].The constipation score and incontinence score at the 24th month after operation were significantly different from those before operation[(5.81±1.28)n(10.92±1.%)J=15.36,P<0.05;(6.03±1.67)vs.(10.81±2.16)J=14.64,P<0.05].But there was no significant difference on the 12th and 24th month after surgery(t=0.85,P>0.05 and t=1.12,P>0.05).Conclusions Laparoscopic rectopexy with Douglas pouch repair plus the procedure for PPH for CRP is a effective treatment.