Feasibility of Transanal Repair of Rectocele

於痔瘡切除術中修補直腸膨出症之可行性

徐洪忠(Hung-Jung Tu) ； 趙培傑(Pei-Chieh Chao) ； 糠榮誠(Jung-Cheng Kang) ； 李家政(Chia-Cheng Lee) ； 饒樹文(Shu-Wen Jao)

《中華民國大腸直腸外科醫學會雜誌》 16卷4期 (2005/12) Pp. 107-111

https://doi.org/10.6312/SCRSTW.2005.16(4).09415

摘要

目的　痔瘡病患同時苦於便秘者不少，在門診病史詢問及理學檢查發現其中部份與直腸膨出症有關。針對這類患者，我們於切除痔瘡的同時順便做經肛門直腸膨出修補手術，並評估其結果。
方法　從1994年3月至2004年3月間共120位嚴重痔瘡女性患者（年齡從34到87歲，平均63歲）同時亦有因直腸膨出引起之排便困難問題。經簡單之病史詢問及肛門指診，確定有直腸膨出症；她們都接受了痔瘡切除及經肛門直腸膨出修補手術。我們對其發出問卷調查，並根據回函予以統計分析，加上術後門診追蹤紀錄，作為成效評估。
結果　術前病人主訴除了痔瘡外，最常見的便秘症狀以手指輔助排便佔最多數。比較統計分析結果，術後症狀改善之比例已達統計意義；其中最顯著者是手指輔助，再依次為陰道下垂感，用力解便及排便不完全感。術後病人對症狀改善的總滿意度約71%（大幅改善：40%；部份改善：31%；無改善：29%；併發症：2.5%）。
結論　合併痔瘡及便秘之婦女，經簡單之臨床診斷確有直腸膨出症者，於痔瘡手術中同時修補直腸膨出，可達七成之便秘改善度，且併發症少，為簡單安全又有效之手術。

關鍵字

經肛門修補手術 ； 直腸膨出症 ； 排便困難 ； 痔瘡切除術

並列摘要

Purpose. To determine whether transanal repair during hemorrhoidectomy can achieve a favorable outcome for symptomatic rectocele.
Methods. We studied 120 female patients (34-87 years old, mean age: 63) with concomitant symptomatic hemorrhoids and rectocele, who underwent transanal repair simultaneously with hemorrhoidectomy during the past ten years. Retrospective analyses were performed using questionnaires and outpatient records.
Results. The most frequent associated symptoms of rectocele preoperatively were vaginal digitation, vaginal lump protrusion, excessive straining, and incomplete evacuation of stool. Postoperative questionnaires revealed significant improvement for all symptoms. The overall patient satisfaction rate was about 71% (greatly improved 40%, improved 31%, and not improved 29%) and the complication rate was 2.5%.
Conclusions. Transanal repair of rectocele during hemorrhoidectomy is a safe, efficient, and convenient method for treatment of symptomatic patients. It is encouraging that through a simple clinical diagnosis, the overall outcome is satisfactory.

並列關鍵字

Rectocele ； Transanal repair ； Hemorrhoidectomy ； Evacuatory difficulty