经肛门直肠乙状结肠部分切除术治疗直肠脱垂27例临床疗效观察

Altemeier’s procedure for rectal prolapse:a clinical review of 27 cases

目的分析经肛门直肠乙状结肠部分切除术(Altemeier术)治疗直肠脱垂的临床疗效。方法回顾性分析2019年3月至2020年3月于山东中医药大学附属医院肛肠科接受Altemeier术治疗,且术前脱垂长度大于5 cm的27例直肠脱垂患者的临床资料。记录患者的手术时间、术中出血量、术后住院时间。术后进行随访,记录并发症发生情况、其他不适症状及患者对治疗效果的满意度,评价肛门括约肌功能及肛门失禁情况。结果27例患者的中位手术时间为99.6(93.5,105.8)min,平均术中出血量为(61.7±23.1)mL,术后平均住院时间为(12.3±3.5)d,无严重感染及死亡患者。术后1个月内,出现大出血1例,新发排粪障碍4例,肛门失禁1例,吻合口炎及增生1例,患者对治疗效果的满意度为37%(10/27)。术后6个月随访,出现吻合口息肉样增生1例,患者对治疗效果的满意度为66.7%(18/27)。术后1年随访,出现脱垂长度≤3 cm的患者3例、排尿障碍1例,患者对治疗效果的满意度为85.2%(23/27);患者中位肛门括约肌功能评分较术前升高、中位Wexner肛门失禁评分较术前降低(均P<0.05),27例患者总体疗效满意。术后无新发肛门坠胀患者,患者肛门坠胀及肛门括约肌松弛表现较术前改善。结论Alte⁃meier术治疗脱垂长度大于5 cm的直肠脱垂患者疗效较为理想,患者满意度较高。

Objectives To examine the clinical effectiveness of Altemeier’s procedure for rectal prolapse.Methods This was a retrospective analysis of 27 patients treated with the Altemeier’s procedure for rectal prolapse at the Department of Anorectal Surgery,Affiliated Hospital of Shandong University of Chinese Medicine,between March 2019 and March 2020.All patients had a preoperative length of prolapse greater than 5 cm.Duration of surgery,intraoperative blood loss,and duration of postoperative hospitalization was recorded.Patients were followed up to record the occurrence of complications,symptoms,and patients’satisfac⁃tion.Sphincter function and anal incontinences were also evaluated.Results Of the 27 patients,the median duration of surgery was 99.6(93.5,105.8)min;mean(SD)intraoperative blood loss was 61.7(23.1)mL;mean(SD)duration of postoperative hospitaliza⁃tion was 12.3(3.5)days.No severe infection or death occurred.Within 1 month after surgery,one patient reported massive bleed⁃ing;four reported new-onset defecation disorder;one reported anal incontinence;one reported anastomotic inflammation and hyper⁃plasia;the overall rate of patients’satisfaction was 37%(10/27).At 6 months after surgery,one patient reported anastomotic polyp⁃oid hyperplasia;the overall rate of patients’satisfaction was 66.7%(18/27).At 1 year after surgery,three patients had prolapse with length≤3 cm;one patient reported urination disorder;the overall rate of patients’satisfaction was 85.2%(23/27).After sur⁃gery,the median sphincter function score increased,and the median Wexner anal incontinence score decreased(P<0.05).Overall effectiveness in the 27 patients was satisfactory.There was no new-onset anal distension.Patients’anal distension and sphincter flaccidity improved after surgery.Conclusion Altemeier’s procedure can achieve satisfactory effectiveness for treating patients with rectal prolapse with a length of prolapse greater than 5 cm.Patients were generally satisfied with the procedure.