[1]魏　巍,李荣先,李红梅,等.改良Delorme手术治疗直肠脱垂临床疗效观察[J].新乡医学院学报,2017,34(8):734-737.[doi:10.7683/xxyxyxb.2017.08.019]
　WEI Wei,LI Rong-xian,LI Hong-mei,et al.Curative effect of modified Delorme operation on patients with proctoptosis[J].Journal of Xinxiang Medical University,2017,34(8):734-737.[doi:10.7683/xxyxyxb.2017.08.019]
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改良Delorme手术治疗直肠脱垂临床疗效观察
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
34
期数:
2017年8
页码:
734-737
栏目:
临床研究
出版日期:
2017-08-05

文章信息/Info

Title:
Curative effect of modified Delorme operation on patients with proctoptosis
作者:
魏　巍1; 李荣先1; 李红梅2; 胡桂芝3; 韦有学4
（1.新乡市中心医院肛肠科，河南　新乡　453000；2.新乡市新华医院肛肠科，河南　新乡　453000；3.新乡市中医院肛肠科，河南　新乡　453000；4.封丘县人民医院肛肠科，河南　新乡　453300）
Author(s):
WEI Wei1; LI Rong-xian1; LI Hong-mei2; HU Gui-zhi3; WEI You-xue4
（1.Department of Anorectum，the Central Hospital of Xinxiang，Xinxiang 453000，Henan Province，China；2.Department of Anorectum，the Xinhua Hospital of Xinxiang，Xinxiang 453000，Henan Province，China；3.Department of Anorectum，the Traditional Chinese Medicine Hospital of Xinxiang，Xinxiang 453000，Henan Province，China；4.Department of Anorectum，the County Hospital of Fengqiu，Fengqiu 453300，Henan Province，China）
关键词:
直肠脱垂; 肛门直肠压力测定; 肛提肌; Delorme手术
Keywords:
rectal prolapse; anorectal manometry; levator ani; Delorme operation
分类号:
R657.1+9
DOI:
10.7683/xxyxyxb.2017.08.019
文献标志码:
A
摘要:
目的　评价改良Delorme手术治疗直肠脱垂的临床效果。方法　选取2010年1月至2015年6月新乡市中心医院、新乡市新华医院、新乡市中医院、封丘县人民医院等4家医院收治的直肠脱垂患者82例，根据手术方式将患者分为对照组和观察组，每组41例。对照组患者采用Delorme手术，观察组患者采用改良Delorme手术（Delorme手术+肛管后方修补术+肛提肌成形术）。对2组患者术后相关指标进行观察。结果　观察组患者手术时间长于对照组 （P<0.05），但2组患者住院时间和术后并发症发生率比较差异无统计学意义（P>0.05）。术后 1.5 a，观察组患者便秘评分、大便失禁患者比率及复发率显著低于对照组，满意度评分高于对照组（P<0.05）；2组患者肛门直肠压力测定结果显示，术后最大静息压及最大收缩压较术前显著升高，直肠感觉容量较术前显著降低（P<0.05），观察组患者最大静息压及最大收缩压显著高于对照组，直肠感觉容量显著低于对照组（P<0.05）。结论　改良Delorme手术远期效果可靠，复发率低，安全性高。
Abstract:
Objective　To evaluate the efficacy of modified Delorme operation for treating proctoptosis.Methods　Eighty-two patients with proctoptosis were selected in the Central Hospital of Xinxiang，Xinhua Hospital of Xinxiang，the Traditional Chinese Medicine Hospital of Xinxiang and he County Hospital of Fengqiu from January 2010 to June 2015.The patients were divided into control group and observation group according to operation methods,41 cases in each group.The patients in the control group were treated with Delorme operation,and the patients in the observation group were treated with modified Delorme operation （Delorme operation and postanal repair and anal levator plasty）.The relevant indexes of postoperative patients in the two groups were analyzed.Results　The operation time in the observation group was significantly longer than that in the control group（P<0.05），but there was no significant difference in the length of stay and the rate of postoperative complication between the two groups（P>0.05）.A year and a half after operation，the constipation scores，fecal incontinence ratio and recurrence rate in the observation group were significantly lower than those in the control group（P<0.05），the satisfaction score in the observation group was significantly higher than that in the control group（P<0.05）.The results of anorectal manometry showed that maximum resting pressure and maximum squeeze pressure after operation were significantly higher than that of before operation，rectal sensation capacity was significantly lower than that of before operation（P<0.05）.The maximum resting pressure and maximum squeeze pressure in the observation group were significantly higher than those in the control group（P<0.05），the rectal sensation capacity in the observation group was significantly lower than that in the control group（P<0.05）.Conclusion　Modified Delorme operation has the long term reliable effect，low recurrence rate and high safety.

参考文献/References:

［1］　魏巍，李保琴，李荣先，等.回顾性分析经腹与经会阴手术治疗完全性直肠脱垂104例［J］.世界华人消化杂志，2015，23（22）：3643-3647.
［2］　GUNDERSEN A L，COGBILL T H，LANDERCASPER J.Reappraisal of Delorme′s procedure for rectal prolapse［J］.Dis Colon Rectum，1985，28（10）：721-724.
［3］　MIK M，TRZCINSKI R，KUJAWSKI R，et al.Rectal prolapse in women-outcomes of perineal and abdominal approaches［J］.Indian J Surg，2015，77（Suppl 3）：1121-1125.
［4］　POYLIN V，BENSLEY R，NAGLE D.Changing approaches to rectal prolapse repair in the elderly［J］.Gastroenterol Rep （Oxf），2013，1（3）：198-202.
［5］　陈孝平，汪建平.外科学［M］.8版.北京：人民卫生出版社，2013：422-423.
［6］　RAO S S，COSS-ADAME E，TANTIPHLACHIVA K，et al.Translumbar and transsacral magnetic neurostimulation for the assessment of neuropathy in fecal incontinence［J］.Dis Colon Rectum，2014，57（5）：645-652.
［7］　LOGANATHAN A，SCHLOITHE A C，HAKENDORF P，et al.Prolonged pudendal nerve terminal motor latency is associated with decreased resting and squeeze pressures in the intact anal sphincter［J］.Colorectal Dis，2013，15（11）：1410-1415.
［8］　AGACHAN F，CHEN T，PFEIFER J，et al.A constipation scoringsystem to simplify evaluation and management of constipated patients［J］.Dis Colon Rectum，1996，39（6）：681-685.
［9］　PESCATORI M，ANASTASIO G，BOTTINI C.A new grading and scoring for anal incontinence.Evaluation of 335 patients［J］.Dis Colon Rectum，1992，35（5）：482-487.
［10］　CANNON J A.Evaluation，diagnosis，and medical management of rectal prolapse［J］.Clin Colon Rectal Surg，2017，30（1）：16-21.
［11］　EMILE S H，ELBANNA H，YOUSSEF M，et al.Laparoscopic ventral mesh rectopexy vs Delorme′s operation in management of complete rectal prolapse：a prospective randomized study［J］.Colorectal Dis，2017，19（1）：50-57.
［12］　HRABE J，GURLAND B.Optimizing treatment for rectal prolapse［J］.Clin Colon Rectal Surg，2016，29（3）：271-276.
［13］　BARFIELD L R.Perineal approaches to rectal prolapse［J］.Clin Colon Rectal Surg，2017，30（1）：12-15.
［14］　JAED M A，AFRIDI F G，ARTIOUKH D Y.What operation for recurrent rectal prolapse after previous Delorme′s procedure? A practical reality［J］.World J Gastrointest Surg，2016，8（7）：508-512.
［15］　SENAPATI A，NICHOLLS R J，CHIR M，et al.Long-term follow-up of the modified Delorme procedure for rectal prolapse［J］.Arch Surg，2003，138（15）：498-503.
［16］　OSMAN M M，ABD E I MAKSOUD W M，GAWEESH Y S,et al.Delorme′s operation plus sphincteroplasty for complete rectal prolapse associated with traumatic fecal incontinence［J］.J Biomed Res，2015，29（4）：326-331.
［17］　ELGADAA A H，HAMRAH N，ALASHRY Y.Complete rectal prolapse in adults：clinical and functional results of delorme procedure combined with postanal repair［J］.Indian J Surg，2010，72（6）：443-447.
［18］　陈朝文，张庚，闫长虹，等.Delorme手术治疗25例直肠脱垂的疗效分析［J］.中华胃肠外科杂志，2012，15（3）：285-287.
［19］　HOTOURAS A，RIBAS Y，ZAKERI S，et al.A systematic review of the literature on the surgical management of recurrent rectal prolapse［J］.Colorectal Dis，2015，17（8）：657-664.
［20］　RICCIARDI R，ROBERTS P L，READ T E，et al.Which operative repair is associated with a higher likelihood of reoperation after rectal prolapse repair［J］.Am Surg，2014，80（11）：1128-1131.
［21］　张峥嵘，武健.低位直肠癌前切除术后综合征发生机制及治疗进展［J］.新乡医学院学报，2016，33（9）：827-829.

更新日期/Last Update: 2017-08-05