Surgical Management of Complete Rectal Prolapse

直腸脫垂手術治療

黃仲琦(Chung-Chi Huang) ； 陳鴻華(Hong-Hwa Chen) ； 林尚潁(Shung-Eing Lin) ； 張家駱(Chia-Lo Chang) ； 盧建璋(Chien-Chang Lu) ； 胡萬祥(Wang-Hseng Hu) ； 李克釗(Ko-Chao Lee)

《中華民國大腸直腸外科醫學會雜誌》 18卷4期 (2007/12) Pp. 99-104

https://doi.org/10.6312/SCRSTW.2007.18(4).09618

摘要

目的　此篇報告主要是回顧本院直腸脫垂手術治療的經驗。
方法　我們收集從西元1997年1月到2006年12月，40位病患在高雄長庚紀念。醫院因直腸脫垂接受手術治療，病例記載以回溯性的方式整理。
結果　男性有16位而24位是女性，平均年齡為59.6±20.7（17歲到86歲），這些病人分成腹部手術組(n=28)及會陰部手術組(n=12)，腹部手術組的病人是接受直腸乙狀結腸切除有或無合併直腸固定術，其中有8位是經由腹腔鏡；重大手術併發症，在腹部手術組的病人有一位發生術後吻合滲漏，而經會陰部手術組的病人也有一位；在術後復發率方面，腹部手術組有兩位(2/28, 7.2%)，而經會陰手術組有4位(4/12, 33.3%), p=0.034; 術後發生再發的病人中，只有兩位接受會陰手術復發的病人再次接受手術，一個改接受腹部手術，而另一位則接受再一次經會陰手術，很不幸這位再次接受經會陰手術的病人手手術中發生腹內出血的情形。
結論　由本院的經驗來看，經腹部手術來治療直腸脫垂的病人明顯比經會陰的手術有較低的復發率，因此較年輕較健康的病人，我們建議先考慮以經腹部的手術來治療直腸脫垂；而經會陰手術通常適用於年紀較大者或手術風險較高的患者，此手術方式一般較高復發率但是手術風險較低。

關鍵字

直腸脫腸 ； 直腸固定術 ； 復發

並列摘要

Purpose. To review our experience in the surgical management of complete rectal prolapse.
Methods. Medical records of 40 patients (16 males, 24 females; mean age 59.6 20.7 years; range 17-86 years) who received surgical treatment of complete rectal prolapse from January 1997 to December 2006 were reviewed retrospectively.
Results. Patients in the abdominal group (n=28) underwent recto-went laparoscopic with or without rectopexy, of which eight patients underwent laparoscopic surgery. No postoperative mortality occurred. Major perioperative complications included one anastomotic leakage in both the abdominal group and the perineal group (n=12). Recurrence rates were 2 of 28 (7.2%) in the abdominal group and 4 of 12 (33.3%) in the perineal group; p=0.034. Only 2 of the latter 4 patients received surgical treatment for the recurrent rectal prolapse (one abdominal procedure and one repeated perineal procedure). The latter patient experienced internal bleeding and was converted to laparotomy.
Conclusions. An abdominal procedure can have a significantly lower recurrence rate than the perineal procedure, and so is recommended for younger and healthier patients. The perineal procedure, which has a higher recurrence rate but lower surgical risk, is more suitable for elderly patients or those with higher operative risk.

並列關鍵字

Rectal prolapse ； Rectopexy ； Recurrence