摘要
目的评估改良Gant-Miwa联合肛门环缩手术治疗成人完全性直肠脱垂的疗效。方法回顾性分析2005年9月至2012年1月间在杭州市第三人民医院接受改良Gant-Miwa联合肛门环缩手术治疗的3l例成人直肠脱垂患者的临床资料。通过肛管直肠测压和Kirwan分级来评价术后肛门功能。结果31例患者手术顺利，手术时间50-165（平均75）min，术中失血量20-80（平均50）ml。术后直肠脱垂症状均消失，无大出血、肛周脓肿、肛瘘、腹腔感染及泌尿生殖功能障碍等并发症发生及围手术期死亡病例，7例出现尿潴留。术后便秘症状缓解率为61．5％（8／13），排粪困难缓解率为69．6％（16／23）。术后2个月，28例患者接受肛管直肠测压，结果显示，直肠感觉阈值和直肠最大耐受量较术前明显降低．肛管静息压和肛管收缩压与术前相比无明显改变。术后6个月，30例患者进行肛门功能Kirwan评级，Ⅰ级22例，Ⅱ级8例。术后26例患者接受了平均2．5年的随访，2例直肠脱垂复发。结论改良Gant-Miwa联合肛门环缩术治疗成人完全性直肠脱垂操作简便、创伤小、术后并发症少、复发率较低，对于年老体弱、合并基础疾病、一般情况欠佳以及不愿经腹手术的患者尤为适宜。
Objective To evaluate the efficacy of modified Gant-Miwa procedure with anal encircling for adults with rectal prolapse. Methods Clinical and follow-up data of 31 adult patients with rectal prolapse undergoing modified Gant-Miwa procedure with anal encircling procedure between September 2005 and January 2012 were retrospectively analyzed. Results Operations were successfully performed in these 31 cases. The mean operation time was 75 （range 50-165 ） minutes. The mean estimated blood loss during operation was 50（range 20-80） ml. There were no postoperative complications, such as hemorrhea, perianal abscess, anal fistula, intra-abdominal infection, or urogenital dysfunction, while only 7 patients developed urinary retention postoperatively. Rate of postoperative constipation improvement was 61.5% （8/13） and defecation difficulty improvement was 69.6% （16/23）. Twenty-eight patients received anal manometry 2 months after operation and the result showed that rectal sensation threshold and rectal maximal tolerance decreased significantly, while anal resting pressure and anal squeeze pressure did not change significantly as compared to preoperative values. Six months after operation, anal function was Kirwan grade Ⅰ in 22 cases and grade Ⅱ in 8 cases. During a mean postoperative follow-up of 2.5 years （3 months-6.3 years）, 2 of 26 patients developed recurrent prolapse. Conclusions Modified Gant-Miwa procedure with anal encircling for adults of rectal prolapse is a simple and safe procedure with low recurrence rate, minimal invasion, no serious complication and mortality, especially suitable for the elderly patients, accompanied with underlying diseases or reluctant to undergo transabdominal operation.
出处
《中华胃肠外科杂志》
CAS
CSCD
2013年第7期641-644,共4页
Chinese Journal of Gastrointestinal Surgery
基金
杭州市科技局（重点专科专病）资助项目（20L00733Q12）
