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직장탈출증의 Delorme 술식 치료의 결과

Results of Delorme’s Procedure for Rectal Prolapse

대한대장항문학회지 2000년 16권 6호 p.407 ~ 414
변성환 ( Byun Sung-Whan ) - 서울적십자병원 외과

김한선 ( Kim Han-Sun ) - 서울적십자병원 외과

Abstract


Purpose: This retrospective study was designed to review and analyze the results of Delorme’s procedure for rectal prolapse.

Methods: Between 1990 and 1999, twenty-nine patients with rectal prolapse underwent Delorme’s procedure. These patients had had no previous operation for rectal prolapse. This study was proceeded retrospectively through the out-patient clinic and by telephone questionnare.

Results: Twelve cases (41%) were males and 17 cases (59%) were females. Mean age was 55.5 years (range,
23∼86 years). The duration of the symptoms was ranged from 3 months to 60 years, with the mean period of 12.2 years. The follow-up period after the operation was from 3 months to 10 years (mean follow-up, 45 months). The internal rectal
prolapses were 11 cases (38%), and the complete rectal prolapses were 18 cases (62%). The common preoperative bowel habits were incontinence with 6 cases (21%) and constipation with 10 cases (34%). After the operation, incontinence and constipation were improved in 4 cases (67%) and 6 cases (60%) respectively. Additional 2 cases of constipation occurred among 19 cases who hadn’t had it preoperatively but the use of laxative helped in improving the symptom. The mean operation time was 71 minutes and in 24 cases (83%), the operation was proceeded with spinal anesthesia. In 27
cases (93%), the amount of bleeding during the operation was less than 100 cc, and in 1 case (3.4%), blood transfusion was needed because the amount was more than 400 cc. The three patients (10%) had postoperative complications(one p erianal abscess due to anastomotic dehiscence and two urinary retention). There was one case of recurrence (3.4%) after the operation and no postoperative mortality.

Conclusion: Delorme’s procedure has the short operation time, causes less bleeding and is possible with regional anesthesia. Delorme’s procedure has low complication rate, results in good bowel function and has a low recurrence rate. Therefore, Delorme’s procedure can be performed with satisfactory outcome in elderly patients and the poor general conditioned patients as well as younger patients. As recurrence rates is low and continence is improved, this procedure may be the preferred initial treatment of all patients with rectal prolapse.

키워드

직장탈출증;Delorme 술식
Rectal prolapse;Delorme’s procedure
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