三种术式治疗38例复发性直肠脱垂的临床疗效分析

Clinical efficacy analysis on three procedures in 38 recurrent rectal prolapse patients

目的分析三种术式(经腹手术、经会阴手术及消痔灵注射疗法)治疗复发性直肠脱垂患者的临床疗效。方法以2012年3月至2022年3月中国中医科学院广安门医院肛肠科收治的38例初次治疗接受经腹手术(直肠悬吊术)、经会阴手术(Altemeier术、Delorme术)及消痔灵注射疗法治疗的复发性直肠脱垂患者为研究对象,按照再手术方式分为经腹组(n=14)、经会阴组(n=5)及注射组(n=19),观察记录患者的手术相关指标及术后随访期间再复发情况。结果经腹组、经会阴组及注射组的手术时间分别为210.0(172.5,330.0)min、30(30,130)min、30(30,30)min,术中出血量分别为50(10,200)mL、10(5,10)m L、0(0,10)mL,平均住院时间分别为(17.7±7.0)d、(18.6±2.7)d、(15.8±4.5)d。经会阴组有2例患者术后出现肛周感染合并发热,经腹组术后9个月出现1例腹壁疝,注射组未出现术后并发症。随访截至2023年3月,中位随访时间为26.5(3.0,100.0)个月。有15例再手术患者再复发。其中经腹组4例,平均再复发时间为(43.0±17.5)个月;经会阴组3例,平均再复发时间为(5.7±2.6)个月;注射组8例,平均再复发时间为(16.9±5.5)个月。有8例患者于再手术1年内再复发。其中经腹组2例,经会阴组和注射组各3例。结论复发性直肠脱垂患者若需再手术进行治疗,需要谨慎选择再手术方案。经腹手术、经会阴手术及消痔灵注射疗法这三种方式各有优劣,应根据临床实际情况进行选择。

Objectives To analyze the clinical efficacy of three procedures(transabdominal,transperineal and Xiaozhiling injection)in the treatment of patients with recurrent rectal prolapse.Methods Thirty-eight patients with recurrent rectal prolapse who received transabdominal surgery(rectal suspension surgery),transperineal surgery(Altemeier surgery and Delorme surgery),and injection therapy with Xiaozhiling from the Department of Anorectal Surgery,Guang’anmen Hospital,China Academy of Chinese Medical Sciences from March 2012 to March 2022 were studied.The patients were divided into transabdominal group(n=14),transperineal group(n=5),and injection group(n=19)according to the different methods of reoperation.The operation-related indicators and postoperative recurrence were observed and recorded.Results The operation time of the transabdominal,transperineal and injection groups was 210.0(172.5,330.0)min,30(30,130)min,and 30(30,30)min,respectively.The intraoperative blood loss was 50(10,200)mL,10(5,10)mL,and 0(0,10)mL,respectively.The average hospital stay was(17.7±7.0)d,(18.6±2.7)d,and(15.8±4.5)d,respectively.Postoperative anal infection and fever occurred in 2 patients in the transperineal group.One case of abdominal wall hernia occurred in the transabdominal group at 9 months after surgery.No postoperative complications occurred in the injection group.As of March 2023,the median follow-up time was 26.5(3.0,100.0)months.Fifteen patients had recurrence after reoperation.Among them,4 cases in the transabdominal group had an average recurrence time of(43.0±17.5)months;3 cases in the transperineal group had an average recurrence time of(5.7±2.6)months;and 8 cases in the injection group had an average recurrence time of(16.9±5.5)months.Eight patients had recurrence within one year after reoperation.Among them,there are 2 cases in the transabdominal group,3 cases in the transperineal group,and 3 cases in the injection group.Conclusion Patients with recurrent rectal prolapse who need reoperation should carefully select the surgical plan.At present,transabdominal surgery,transperineal surgery and injection therapy with Xiaozhiling are reliable choices for the treatment of recurrent rectal prolapse.According to the actual clinical situation,they can be selected accordingly.