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완전 직장탈 환자에서 경회음 직장에스상결장 절제술 및 항문거근 성형술의 단기 성적에 대한 고찰

Perineal Rectosigmoidectomy with Levatoroplasty for Rectal Prolapse Early functional outcome

대한대장항문학회지 2001년 17권 5호 p.220 ~ 226
윤서구, 이종호, 윤종섭, 김건욱, 김현식, 이종균, 김광연,
소속 상세정보
윤서구 ( Yoon Seo-Gu ) - 송도병원 외과
이종호 ( Lee Jong-Ho ) - 송도병원 외과
윤종섭 ( Yoon Jong-Sub ) - 송도병원 외과
김건욱 ( Kim Khun-Uk ) - 송도병원 외과
김현식 ( Kim Hyun-Sik ) - 송도병원 외과
이종균 ( Lee Jong-Kyun ) - 송도병원 외과
김광연 ( Kim Kwang-Yeon ) - 송도병원 외과

Abstract


Purpose: This study was designed to analyze the short- term clinical and functio nal outcomes of perineal rectosigmoidectomy with levatoroplasty for complete rec tal prolapse.

Methods: The data were prospectively collected and consisted of the clinical data, the functional status before and after surgery, the operation record, and the postoperative course. The functional status was evaluated by using Wexner’s constipation score (0∼30), Wexner’s incontinence score (0∼20), anorectal manometry, and pudendal nerve terminal motor latency. Follow-up was performed at 3∼6 months after the operation by using both a standardized questionnaire completed in the outpatient clinic or telephone interview (n=23) and an anorectal physiology test (n=7).

Results: During a one-year period, 23 patients (male=10) underwent perineal rectosigmoidectomy with levatoroplasty for complete rectal prolapse. The median duration of the operations was 88 minutes. The median length of postoperative hospital stay was 6 days. There was one urinary tract infection and no mortalities. The constipation score was significantly decreased after the operation (9.8 vs 3.8; P<0.001), and constipation was improved in 90 percent (19/21) of the cases. The incontinence score was significantly decreased after surgery (mean preop.=11.6, postop.=3.7; P<0.001) and incontinence was improved in 17 of 21 patients with impaired continence (81 percent). Anal sphincter function was not improved but rectal reservoir capacity was significantly decreased after surgery (rectal urgent volume (45.7 cc vs 37.1 cc; P=0.045), maximal tolerable volume (120 cc vs 85.7; P=0.011). Most patients (83 percent) felt that the operation had improved their symptoms. The major reasons for dissatisfaction after surgery were frequent defecation, fecal soiling, persistent or aggravated fecal incontinence, and recurrence. One patient had a complete recurrence (4.3 percent), and another patient had a mucosal prolapse which was treated.

Conclusion: Perineal rectosigmoidectomy with levatoroplasty for complete rectal prolapse is a safe technique with acceptable short-term functional results; however, it is not recommended for rectal prolapse patients with diarrhea- predominant irritable bowel syndrome.

키워드

직장탈;직장에스상결장 절제술; 항문거근 성형술;변비;변실금
Rectal prolapse;Rectosigmoidectomy;Levatoroplasty;Constipation;Fecal incontinence

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