Surgical Treatment for Rectal Prolapse in the Last Decade at Taipei Veterans General Hospital

近十年台北榮總對直腸脫垂的外科治療經驗

張智閑(Chih-Hsien Chang) ； 藍苑慈(Yuan-Tzu Lan) ； 姜正愷(Jeng-Kai Jiang) ； 張世慶(Shih-Ching Chang) ； 王煥昇(Huann-Sheng Wang) ； 林宏鑫(Hung-Hsin Lin) ； 林春吉(Chun-Chi Lin) ； 黃聖捷(Sheng-Chieh Huang) ； 鄭厚軒(Hou-Hsuan Cheng) ； 林楨國(Jen-Kou Lin) ； 林資琛(Tzu-Chen Lin) ； 楊純豪(Shung-Haur Yang) ； 陳維熊(Wei-Shone Chen)

《中華民國大腸直腸外科醫學會雜誌》 33卷3期 (2022/09) Pp. 172-179

https://doi.org/10.6312/SCRSTW.202209_33(3).11123

摘要

Purpose. Surgery has been identified as the only curative treatment for rectal prolapse. However, there is yet no consensus on the choice of operative methods. Thus, the aim of this study was to determine the surgical treatment choices for rectal prolapse in a single hospital and the differences between the procedures. Materials and Methods. Patients who underwent surgical treatment for rectal prolapse at Taipei Veterans General Hospital from 2010 to 2019 were enrolled in this study. Demographic data, surgical procedures, surgical complications, and recurrence were retrospectively collected from medical records and operative notes, and surgical outcomes for the abdominal and perineal approaches were compared. Results. In total, 79 predominantly female patients were included in this study. Abdominal approach was used in 47 (59.5%) patients, and no significant differences were detected in most characteristics between the two approaches. The American Society of Anesthesiologists scores of III and IV occurred more frequently in patients who underwent the perineal approach (p = 0.029). Postoperative complications were reported in 16 (34.0%) patients who underwent the abdominal approach and 11 (34.4%) patients who underwent the perineal approach. Three patients underwent another operation due to complications after the abdominal approach. The median follow-up time was 51 and 62 months for the abdominal and perineal approaches respectively. Recurrence rates were similar for two groups (A/P: 14.9%/25.0%, p = 0.261). Since 2015, the number of surgeries for rectal prolapse was noted to increase at our hospital. Laparoscopic assist was applied more frequently since 2017. Conclusion. Rectal prolapse is known to be a relatively rare condition in current practice. The choices of surgical approach should be personalized based on the patients' medical conditions, surgical risks and postoperative complications. Laparoscopic assist is a choice for skilled surgeons.

關鍵字

Rectal prolapse ； Surgery ； Outcome

並列摘要

直腸脫垂有效的治療方式分為經腹部或經會陰部手術，本篇文章想探討在台北榮總醫院執行兩種手術所產生的差異。我們收集2010至2019年於台北榮總接受直腸脫垂手術的患者，回顧其病歷並分析。79位患者被納入討論，其中女性為主。有47（59.5%）位病人採經腹部手術；其餘的病人採經會陰部手術。兩者之間僅在麻醉風險分數上有差異，三或四分的患者較常接受經會陰手術。經腹部手術及經會陰部手術後發生併發症，並無比例上的差異；且兩組復發比率相似。在我們醫院，自2015年後接受直腸脫垂手術的患者人數上升，且於2017年後腹腔鏡使用率上升。臨床上直腸脫垂並不常見，手術治療的選擇應依照病人狀況及手術風險……等作選擇。對於技術純熟的外科醫師來說，腹腔鏡手術亦為一個好選擇。

並列關鍵字

直腸脫垂 ； 手術 ； 預後