摘要
目的探讨改良Frykman-Goldberg手术治疗成人直肠脱垂的临床疗效及其安全性。方法2010年2月至2020年5月本科室采用改良Frykman-Goldberg手术治疗成人直肠脱垂患者共29例,患者筛选标准为年龄在18周岁以上,保守治疗效果不佳,直肠脱出长度在4 cm及以上,能够耐受经腹手术。记录手术相关情况及术后随访情况。结果在29例患者中,行开腹手术6例、腹腔镜辅助手术21例、达芬奇机器人辅助手术2例。所有手术均顺利完成,术中见盆底直肠膀胱(子宫)陷凹明显加深,手术时间45~120 min,平均手术时间为(80±25)min,术中出血量20~240 mL,平均术中出血量为(50±18)mL,未发生输尿管损伤、骶前静脉损伤、吻合口漏、排尿功能障碍和腹盆腔感染等手术并发症。术后中位随访4年,患者均未出现肛门坠胀感、排粪困难、排粪不尽感等症状,亦未出现排尿困难及性功能障碍等并发症。3例患者术后评估为Ⅰ度大便失禁,经生物反馈治疗1~2个疗程后完全恢复;1例患者术后评估为Ⅲ度大便失禁,术后3个月时二期用10#丝线行肛门紧缩术,后症状明显好转。2例患者分别于术后5个月、2年时出现直肠黏膜脱垂,经PPH手术治愈。1例患者于术后1年复发,手术治愈率为96.6%(28/29)。结论采用改良Frykman-Goldberg手术治疗成人直肠脱垂疗效确切、并发症少且操作简单,具有良好的临床应用价值。
Objectives To explore the clinical effectiveness and safety of modified Frykman-Goldberg procedure for adult rectal prolapse.Methods Between February 2010 and May 2020,our department performed modified Frykman-Goldberg procedures for 29 adult patients with rectal prolapse.Inclusion criteria:age>18 years,failed conservative treatment,length of prolapsed rectum>4 cm,and indication for transabdominal surgery.Indices related to surgery and postoperative follow-up were analyzed.Results Of the 29 patients,six underwent transabdominal surgery,21 underwent laparoscopic surgery,and 2 underwent Da Vinci roboticassisted surgery.All surgeries were uneventful.Significantly deepened pelvic floor rectum bladder(uterus)depression was ob⁃served during the surgeries.The duration of surgery was 45~120 minutes,and the mean(SD)duration of surgery was 80(25)min⁃utes.The intraoperative blood loss was 20~240 mL,and the mean(SD)intraoperative blood loss was 50(18)mL.There was no ureteral injury,presacral vein injury,anastomotic leakage,micturition dysfunction,and abdominal or pelvic infection.The median postoperative follow-up was 4 years.No patients reported symptoms such as anal distension,difficulty to defecate,and incom⁃plete defecation.There were also no reports of complications such as difficulty to urinate and sexual disfunction.After the sur⁃gery,three patients had gradeⅠfecal incontinence and completely recovered after 1 to 2 courses of biofeedback therapy.One patient had gradeⅢfecal incontinence,and the patient’s symptoms improved after secondary anal tightening surgery with 10#silk thread at 3 months after surgery.Two patients developed symptoms of rectal mucosal prolapse at 5 months and 2 years af⁃ter surgery,respectively,and the procedure for prolapsed hemorrhoids cured both.One patient experienced recurrence 1 year af⁃ter surgery.The overall success rate was 96.6%(28/29).Conclusion Modified Frykman-Goldberg procedure is an effective treat⁃ment with fewer complications for adult rectal prolapse.It is an easy-to-perform procedure and has the potential for greater clini⁃cal application.
作者
高峰
徐明
宋枫
杨增强
吴伟强
高华
Gao Feng;Xu Ming;Song Feng;Yang Zengqiang;Wu Weiqiang;Gao Hua(Department of Colorectal and Anal Surgery,The 940^(th)Hospital of Joint Logistics Support Force of PLA,Lanzhou 730050,Gansu,China)
出处
《结直肠肛门外科》
2021年第4期348-351,共4页
Journal of Colorectal & Anal Surgery
基金
军队后勤科研项目(16BJZ48)
甘肃省自然科学基金(17JR5RA331)。
