摘要
背景 直腸脫垂是一個令人困擾的疾病，至目前依然沒有明顯的主要治療選擇。在這份研究報告中，我們將回顧處理直腸脫垂的經驗。 方法 自西元1993年至西元2004年間，18位患有直腸脫垂的病人接受手術治療。病例記載以回溯性的方式整理。 結果 9位男性及9位女性，平均年齡49.9歲（從16到86歲）。5位接受直腸縫合固定手術，4位接受經由腹部乙狀結腸切除及直腸縫合固定手術，3位接受腹腔鏡大腸切除合併或不合併人工網膜直腸固定手術，2位接受經由會陰直腸乙狀結腸切除手術，2位接受Delorme氏手術，2位接受Thiersch氏手術。平均追蹤時間5.5年。在5位接受直腸縫合固定手術的病人中，沒有併發症但有一例復發(20%)。接受經由腹部乙狀結腸切除及直腸縫合固定手術的4位病人中，沒有併發症或是復發的病例。3位接受腹腔鏡手術的病人也沒有併發症或是復發的情形。2位接受經由會陰直腸乙狀結腸切除手術的病人同樣沒有併發症或是復發。1位接受Thiersch氏手術的病人併發肛門周圍感染，1位接受Delorme氏手術的病人復發。全部併發症比率為5.6%，復發比率為11.1%。 結論 沒有一種手術是適合所有直腸脫垂的病人，也沒有種手術可以解決所有的症狀。根據我們的經驗及文獻回顧，經由腹部的手術適合較年輕健康的病人，而經會陰的手術則適用於年紀較大且身體虛弱的病人。雖然追蹤的時間還不夠長無法下結論，我們相信腹腔鏡手術提供另一個可能有效的治療選擇。
並列摘要
Background. The problem of complete rectal prolapse is formidable, with no clear predominant treatment of choice. In the present study, we review our experience with rectal prolapse. Mathod. From the 1993 to 2004, 18 patients with full-thickness rectal prolapse were treated with surgical procedures. The medical records were reviewed retrospectively. Results. There are 9 males and 9 females with a mean age of 49.9 years (Range 16-86). Five patients received suture rectopexy, four patients underwent open sigmoidectomy with suture rectopexy, three patients received laparoscopic colectomy with or without mesh rectopexy, two patients were treated with perineal rectosigmoidectomy, two patients received Delorme procedure, and two patients underwent Thiersch procedure. The median follow up times were 5.5 years. In the five patient received suture rectopexy, there was no complication but one patient recurred (20%). In the four patients received open sigmoidectomy with suture rectopexy, there was no complication or recurrence. In the group of laparoscopic colectomy with or without mesh rectopexy, no complication or recurrence occurred. In the perineal rectosigmoidectomy group, there was also no complication or recurrence. There was one complication of perianal infection in the Thiersch group and one recurrence in the Delorme group. Of the total 18 patients, the complication rate was 5.6% and the recurrence rate was 11.1% Conclusions. There is probably no single operation that is suitable for all patients and no operation will produce complete resolution of all symptoms. Abdominal procedures are ideal for young fit patients, whereas perineal procedures are reserved for older frail patients with significant comorbidities, because in our series and in reviewing the literature, abdominal procedures provide lower recurrence rates. Although the follow up time was not long enough for conclusions, laparoscopic operations offer a promising new option for the treatment of rectal prolapse.
延伸閱讀
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