腹腔镜下直肠脱垂悬吊固定并乙状结肠折叠术治疗完全性直肠脱垂患者的临床效果

Clinical effect of laparoscopic suspension fixation combined with Sigmoid colon folding in treatment of complete rectal prolapse

摘要:

目的 分析直肠脱垂悬吊固定并乙状结肠折叠术治疗完全性直肠脱垂患者的临床效果。方法 将贵州中医药大学第一附属医院2017年2月至2023年5月收治的50例完全性直肠脱垂患者，按照手术方式的不同分为对照组（20例）和观察组（30例）。对照组患者行直肠黏膜切除肌层折叠术，观察组患者行直肠脱垂悬吊固定并乙状结肠折叠术。比较2组临床疗效、术后30 d临床恢复情况、并发症、术后1年复发率、治疗前后肛门直肠压力等情况；功能疗效根据Wexner大便失禁评分评价。结果 观察组总治愈率高于对照组（P=0.012）。术后30 d，观察组肛门坠胀（t=2.300，P=0.026）、控便能力（t=2.299，P=0.026）、肛门潮湿评分低于对照组（t=2.205，P=0.032）。术后1月，观察组并发症总发生率低于对照组（χ²=6.255，P=0.012）。术后90 d，2组患者直肠感觉容量均减少（t=20.634，P<0.001），最大静息压（maximum resting pressure，MRP）、最大收缩压（maximal squeeze pressure，MSP）均增加，且观察组MRP（t=-11.486，P<0.001）、MSP（t=-7.358，P<0.001）高于对照组。随访1年后观察组复发率低于对照组（P=0.033）。术后3个月，2组患者排气、液体大便、固体大便、佩戴护垫及生活方式改变总评分，差异无统计学意义（t=0.197，P=0.845）。结论 直肠脱垂悬吊固定并乙状结肠折叠术治疗完全性直肠脱垂患者的临床疗效优于Delorme术，术中创伤小，并发症少，恢复快且远期复发率低。

Abstract:

Objective To investigate the clinical effect of suspension fixation combined with Sigmoid colon folding in the treatment of complete rectal prolapse.Methods A total of 50 patients with complete rectal prolapse who were admitted to The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine from February 2017 to May 2023 were enrolled，and according to the surgical procedure，they were divided into control group with 20 patients and observation group with 30 patients. The patients in the control group underwent Delorme surgery，and those in the observation group underwent suspension fixation combined with Sigmoid colon folding for rectal prolapse. The two groups were compared in terms of clinical outcome，clinical recovery on day 30 after surgery，complications，recurrence rate at 1 year after surgery，and anorectal pressure before and after treatment，and functional efficacy was evaluated based on Wexner fecal incontinence score.Results The observation group had a higher overall cure rate than the control group（P=0.012）. On day 30 after surgery，compared with the control group，the observation group had significantly lower scores of anal pendant expansion（t=2.300，P=0.026），stool control ability（t=2.299，P=0.026），and anal moisture（t=2.205，P=0.032）. At 1 month after surgery，the observation group had a significantly lower overall incidence rate of complications than the control group（χ²=6.255，P=0.012）. On day 90 after surgery，both groups had a significant reduction in rectal sensory volume（t=20.634，P<0.001） and significant increases in maximum resting pressure（MRP） and maximum squeeze pressure（MSP），and the observation group had significantly higher MRP（t=-11.486，P<0.001） and MSP（t=-7.358，P<0.001） than the control group. After 1 year of follow-up，the observation group had a lower recurrence rate than the control group（P=0.033）. At 3 months after surgery，there was no significant difference between the two groups in the total score of passing of flatus，liquid stool，solid stool，pad wearing，and lifestyle change（t=0.197，P=0.845）.Conclusion Suspension fixation combined with Sigmoid colon folding has a better clinical effect than Delorme surgery in the treatment of complete rectal prolapse，with less intraoperative trauma，fewer complications，faster recovery，and a lower long-term recurrence rate.