Initial Experience with Stapled Transanal Rectal Resection under Laparoscopic Surveillance for Rectocele and Rectal Internal Intussusception

在腹腔鏡監視下，經肛門以吻合器行直腸切除治療直腸前突及直腸內套疊的最初經驗

張世昌(Shih-Chang Chang) ； 沈明宏(Ming-Hung Shen) ； 李興中(Henry Hsin-Chung Lee)

《中華民國大腸直腸外科醫學會雜誌》 22卷2期 (2011/06) Pp. 50-56

https://doi.org/10.6312/SCRSTW.2011.22(2).09915

摘要

目的：直腸前突（rectocele）及直腸內套疊（rectal internal intussusceptions）是出口阻塞型便秘的器質性原因。針對出口阻塞型便秘，經肛門以吻合器行直腸切除 （STARR）在近年來成為手術選擇的一種方法。這篇文章描述了我們在腹腔鏡監視下，經肛門以吻合器行直腸切除的最初經驗。病人及方法：5個同時有直腸前突及直腸內套疊的病人，接受了在腹腔鏡監視下，經肛門以吻合器行直腸切除。結果：在併發症方面，有2個病人在吻合處發生了術後立即性的出血；3個病人有暫時性的排氣失禁；還有2個病人有暫時性的急迫性尿失禁。術後疼痛感是很低的；這5個病人都不需要術後使用肌肉注射止痛針。術後沒有發生如腹腔內出血、直腸陰道瘻管或吻合處膿瘍等主要併發症。術後，所有的病人在排便用力、裡急後重及排便不全感上都有明顯的改善。並無排便失禁的情形。結論：針對同時有直腸前突及直腸內套疊的病人，在腹腔鏡監視下，經肛門以吻合器行直腸切除是個有效且安全的手術方法。在施行經肛門以吻合器行直腸切除時，結合腹腔鏡可以避免如腸脫垂（enterocele）而造成的腹腔內器官傷害及直腸陰道瘻管等的發生。

關鍵字

經肛門以吻合器直腸切除（STARR） ； 直腸前突 ； 直腸內套疊 ； 出口阻塞型便秘

並列摘要

Purpose. Rectocele and rectal internal intussusception are two organic causes of obstructed defecation syndrome. Asurgical procedure called the stapled transanal rectal resection (STARR), is gaining acceptance as a recommended surgical option to treat these types of obstructed defecation syndrome. We report the initial experience with the stapled transanal rectal resection under laparoscopic surveillance.Patients and Methods. Five patients with symptomatic rectocele and coexistent intussusception underwent STARR procedure combined with laparoscopic surveillance.Results. Post-operative complications included immediate postoperative staple line bleeding in two cases, transient incontinence to flatus in three cases and temporary urge incontinence of flatus in two cases. The postoperative subjective sense of pain was low; all five patients did not need any IM analgesics. In addition, no major complications such as intraabdominal bleeding, rectovaginal fistula or late abscess in the staple line were observed. Postoperatively, all patients experienced better defecation with less straining, less tenesmus and less sensation of incomplete evacuation. No fecal incontinence was detected.Conclusion. STARR procedure under laparoscopic surveillance appears to be a safe and effective therapy for obstructive defecation disorder caused by symptomatic rectocele with internal intussusception. The combination of stapled transanal rectal resection procedure and laparoscopy avoids the threat of intra-abdominal lesions resulting from enterocele or rectovaginal fistula.

並列關鍵字

Stapled transanal rectal resection (STARR) ； Rectocele ； Intussusception ； Obstructive defecation disorder