Laparoscopic Rectopexy with Sigmoid Resection for Full-thickness Rectal Prolapse

腹腔鏡直腸固定術倂乙狀結腸切除術治療全層直腸脫垂

方川尹(Chuan-Yin Fang) ； 朱峻廷(Chun-Ting Chu) ； 黃允中(Yun-Chung Huang) ； 林怡成(I-Chen Lin)

《中華民國大腸直腸外科醫學會雜誌》 32卷4期 (2021/12) Pp. 159-167

https://doi.org/10.6312/SCRSTW.202112_32(4).11014

摘要

Purpose. This study aims to evaluate the efficacy and safety of laparoscopic rectopexy with sigmoid resection in patients with full-thickness rectal prolapse. Methods. Eighteen patients with full-thickness rectal prolapse, who underwent laparoscopic rectopexy with sigmoid resection in our institution, were enrolled from January 2014 to March 2020.We retrospectively evaluated and analyzed their demographic data, perioperative results, and short-term functional outcome. Results. The median age was 73.2 (±16) years. The male to female ratio was 0.2 (3/15). Preoperative clinical symptoms such as constipation occurred in 77.8% (14/18) of patients, and incontinence in 88.9% (16/18) of patients. Patients' preoperative risk according to American Society of Anesthesiologists (ASA) score included: ASA I = 22.2% (5/18), ASA II = 50% (9/18), and ASA III = 27.8% (4/18). Mean operation times were 199.1 (±44.3) min and the mean blood loss was 35.2 mL. There were five minor perioperative complications: one anastomotic bleeding, one delayed ileus, two urinary retention, and one surgical wound infection. There were no major complications or surgical mortality in this series. Mean hospital stay was 9.78 (±1.8) days. Functional outcome after one year follow-up showed improvement of constipation status in 85.7% (12/14) of patients with preoperative constipation, and improvement of incontinence status in 87.5% (14/16) of patients with preoperative incontinence. The overall recurrence rate was 5.6% (1/18). Finally, 83.3% (15/18) of patients were satisfied with the functional outcome of the operation. Conclusions. Laparoscopic rectopexy with sigmoid resection is a safe and effective surgical option for patients with full-thickness rectal prolapse regarding recurrence rate, bowel function, and risk.

關鍵字

Laparoscopy ； Rectopexy with sigmoid resection ； Full-thickness rectal prolapse

並列摘要

目的：本研究的目的是評估腹腔鏡直腸固定術併乙狀結腸切除術治療全層直腸脫垂患者的療效和安全性。方法：2014年1月至2020年3月，在本院接受腹腔鏡直腸固定術併乙狀結腸切除術的全層直腸脫垂患者18例。我們回顧性地評估和分析了患者的人口統計學數據、手術期間併發症和短期腸道功能結果。結果：共分析了18名患者。中位數年齡為73（±16）歲。男女比例為0.2（3/15）。77.8%（14/18）的患者術前出現便秘症狀，88.9%（16/18）患者出現大便失禁。根據ASA評分，患者的術前風險包括：ASA I 22.2%（5/18）、ASA II 50%（9/18）和ASA III 27.8%（4/18）。平均手術時間為199.1分鐘，平均失血量為35.2 ml。手術期間輕微併發症5例，包括：吻合口出血1 例，延遲性腸脹氣1例，尿滯留2例，手術傷口感染1例，無嚴重併發症，無手術死亡。平均住院時間為9.78天。追蹤1年後的腸道功能結果顯示：85.7%（12/14）的術前便秘患者的便秘狀態得到改善，87.5%（14/16）的術前失禁患者的失禁狀態得到改善。總體復發率為5.6%（1/18）。最後，83.3%（15/18）的患者對手術的功能結果感到滿意。結論：考慮到復發率、腸道功能和風險，腹腔鏡直腸固定術併乙狀結腸切除術作為全層直腸脫垂的手術選擇是安全有效的。

並列關鍵字

腹腔鏡 ； 直腸固定術併乙狀結腸 ； 全層直腸脫垂

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