腹腔镜改良直肠前切除术治疗成人重度直肠脱垂的临床效果

The Chinical Efficacy of Modified Anterior Rectectomy under Laparoscope for the Treatment of Severe Rectal Prolapse in Adults

目的探讨腹腔镜改良直肠前切除术治疗成人重度直肠脱垂的临床效果。方法选择2013年4月至2018年5月于医院肛肠科住院治疗的58例重度直肠脱垂患者作为研究对象,按照入院顺序编号将双号作为对照组,单号作为试验组,每组29例。对照组采用开腹改良直肠前切除术治疗,试验组采用腹腔镜改良直肠前切除术治疗,比较两组的手术情况、并发症及复发情况。结果试验组手术时间长于对照组,术中出血量少于对照组,肛门排气时间短于对照组,差异均有统计学意义(P<0.05);两组标本切除长度比较,差异无统计学意义(P>0.05);两组吻合口出血发生率比较,差异无统计学意义(P>0.05);试验组肛门会阴疼痛、切口疼痛、坠胀和大便不尽、肺部感染、切口感染的发生率均低于对照组,差异有统计学意义(P<0.05);两组复发率比较,差异无统计学意义(P>0.05)。结论腹腔镜改良直肠前切除术治疗成人重度脱垂患者能够减少术中出血量,缩短肛门排气时间,降低术后并发症发生率,且不会增加复发风险。

Objective To investigate the clinical efficacy of modified anterior rectectomy under laparoscope for the treatment of severe rectal prolapse in adults.Methods 58 cases with severe rectal prolapse adimitted to the anorectal department in the hospital from April 2013 to May 2018 were enrolled in this study.According to the sequence number of patients admitted to the hospital,the patients with even number were defined as the control group and those with odd number were defined as the test group,with 29 cases in each group.The patients in the control group were treated with modified anterior rectocelectomy by means of laparotomy,and those in the test group were treated with modified anterior rectectomy under laparoscope.The operation status,complications and recurrence status were compared between the two groups.Results The operation time of the test group was longer than that of the control group,the intraoperative blood loss of the test group was less than that of the control group and the time taken for anus exhausting was shorter than that of the control group,all the differences were statistically significant(P<0.05).There was no significant difference in the excision length of the specimens between the two groups(P>0.05).There was no significant difference in the incidence of anastomotic bleeding between the two groups(P>0.05).The incidences of anoperineal pain,incision pain,distension,incomplete pooping,lung infection and incision infection in the test group were all lower than those in the control group,and the differences were all statistically significant(P<0.05).There was no significant difference in the recurrence rate between the control group and the test group(P>0.05).Conclusion The intraoperative blood loss could be reduced,the time taken for anus exhausting could be shorten,the postoperative complicatons incidence could be reduced and the recurrence risk could not be increased in treating the severe rectal prolapse in adults by modified anterior rectectomy under laparoscope.