腹腔镜下直肠骶骨岬固定术治疗完全性直肠脱垂的技术性与功能性结果:54例连续患者的前瞻性研究

作     者：Auguste T. Dubreuil A. Bost R. J.-L. Fauch-eron 纪泛扑 

作者机构：Unitéde Chirurgie Colorectale Département de Chirurgie Digestive et de l'UrgenceBP 217 38043 Grenoble France 

出 版 物：《世界核心医学期刊文摘（胃肠病学分册）》 (Core Journals in Gastroenterology)

年 卷 期：2006年第2卷第11期

页      面：17-18页

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

主　　题：完全性直肠脱垂 腔镜 肛门失禁 术后评估 短期效果 结肠传输时间 开腹手术 生活质量问卷 排粪造影 

摘      要：Introduction -Laparoscopic rectopexy for complete rectal prolapse offers short-term advantages compared with operations performed by laparotomy. The aim of this prospective study was to report technical and functional outcome after laparoscopic rectopexy to the promontory in consecutive patients operated on by a single surgeon. Patients and methods -From May 1996 to July 2004, 54 consecutive patients (47 women), median age 53 years (range: 16-84 years), underwent laparoscopic rectopexy to the promontory for complete rectal prolapse. Preoperative evaluation included physical examination, dynamic videoproctography and, in patients with constipation, colonic transit time (with radiopaque markers). Postoperative evaluation included the same examinations and a simple global quality-of-life questionnaire. Results -Conversion to laparotomy was required for three patients during the learning curve. Median duration of operation was 157 minutes (range: 50 -370). There was no mortality and morbidity was 5.5%(brachial plexus palsy in two patients and urinary tract infection in one). Median hospital stay was 3.5 days (range: 1 -11). There were 4 recurrences (7.4%). Functional outcome at 12 months showed the presence of constipation in 20.3%of patients (persistence in eight and de novo in three) and the presence of outlet obstruction in 25.9%of patients (persistence in six and de novo in eight). Anal continence improved in 72.4%of the 29 patients who complained of this symptom. The global quality-of-life questionnaire showed a satisfactory result in 96%of patients. Conclusion -Laparoscopic rectopexy to the promontory is a safe and efficient procedure to treat complete rectal prolapse; morbidity is low. Functional outcome is at least equivalent to that obtained with open procedures in terms of continence, constipation and outlet obstruction.