잠시만 기다려 주세요. 로딩중입니다.

직장탈출증후군의 병인과 외과적 치료

Pathogenesis and Surgical Treatment of Rectal Prolapse Syndrome

대한대장항문학회지 1998년 14권 2호 p.225 ~ 233
김진천 ( Kim Jin-Cheon ) - 울산대학교 의과대학 서울중앙병원 일반외과학교실

김창남 ( Kim Chang-Nam ) - 을지대학교 의과대학 외과학교실
박상규 ( Park Sang-Kyu ) - 울산대학교 의과대학 외과학교실
김숙영 ( Kim Suk-Young ) - 울산대학교 의과대학 외과학교실
유창식 ( Yu Chang-Sik ) - 울산대학교 의과대학 외과학교실

Abstract


The rectal prolapse syndome is a disease entity includes rectocele and rectal prolapse, presenting prolapse(procidentia) of rectum. In rectocele, rectum is prolapsed anteriorly into the vagina, whereas in procidentia, inferiorly out of the anus. This study was aimed at analyzing pathogenesis and adequacy of surgical treatment in rectocele and rectal prolapse. Twenty-one patients with rectocele and 18 patients with rectal prolapse were assessed pre- and post-operatively in respect to symptoms and signs, pathogenesis, defecography, and manometry. In analysis of symptoms and sings, constipation was the commonest in both diseases(86% of rectocele and 67% of rectal prolapse) and incontinence was not infrequently found in both diseases as well(14% of rectocele and 33% of rectal prolapse). In analysis of the underlying causes, two patients with rectal prolapse had prolapse from childhood. Defecography showed anorectal angle of rectal prolapse in rest and push period. They were significantly wider than those of rectocele(p<0.05). The perineal descent of rectal prolapse was longer than that of rectocele. In analysis of the associated factors, average number of delivery was more than three times in both diseases(3.5 of rectocele and 5.1 of rectal prolapse). We could easily find previous operation history in both diseases. Among them, hysterectomy was the most frequent, especially in patients with rectocele. The hemorrhoids was associated more common in rectocele than in rectal prolapse(p<0.05). Preoperative maximal resting pressure of rectal prolapse was more significantly decreased than that of rectocele(p<0.05). The sensation of fullness was significantly decreased in patients with rectal prolapse postoperatively(p<0.05). Patients with rectocele underwent levator plication by transrectal or vaginal approach. Patients with rectal prolapse underwent posterior rectopexy in 11 patients, resection and rectopexy in 3 patients, Delorme’s operation and Thiersch operation in 2 patients each.
Constipation was significantly improved in patients with rectocele postoperatively(p<0.05). Incontinence was markedly improved in patients with rectal prolapse postoperatively(p< 0.05). At the interview about subjective improvement of symptom, 95% of patients with rectocele and 89% of patients with rectal prolapse were satisfied with surgery. In conclusion, rectocele and rectal prolapse can be categorized as rectal prolapse syndrome because both diseases have anatomical derangements caused by similar pathogenesis such as altered bowel habits, anatomical factor, delivery, past history of hysterectomy, and hemorrhoids. Levator plication and posterior rectopexy seem to be useful surgical methods of anatomical repair for the respective disease.

키워드

Rectal prolapse syndrome;Rectocele;Rectal prolapse;Pathogenesis;Surgical
원문 및 링크아웃 정보
  
등재저널 정보
KCI
KoreaMed
KAMS