(英文文献翻译)会阴吻合术治疗直肠脱垂：长期值得吗？

以前翻译的文献，给大家分享。最后附原文。

perineal stapled(钉合) prolapse resection（切除术） for external rectal prolapse:is it worthwhile（值得的） in the long-term?

会阴吻合术治疗直肠脱垂：长期值得吗？

介绍

会阴吻合器脱垂（PSP）切除术是治疗直肠外脱垂的一种新术式。

然而，文献中没有长期的研究结果。本研究分析PSP切除术的长期复发率、预后效果和

2007年至2011年间，9例接受PSP切除术的患者被前瞻性地随访。手术是由同一个外科医生在一种标准化的技术。

预期评估手术的复发率、预后效果和并发症程度。

9例接受PSP切除术的患者调查过。中位数年龄为72岁。

术中无并发症。

大便失禁，术前2例，

1例术后病情恶化。

1例出现新发大便失禁

梗阻性排便综合征术后评分从11分显著下降到5。

平均随访40个月，

脱垂复发率44%。

PSP切除术是一种快速、安全、并发症少的手术。然而，长期功能不良的预后和44%的复发率需要谨慎的病人选择。

Introduction

会阴入路被认为是老年和多种疾病的患者的手术策略，因为它与低发病率相关。

Delorme和altemier手术是两种最常用的会阴技术。

与腹部技术相比，

会阴入路有一些主要的缺点，如减少了控制和增加了复发率。

与Delorme手术相比，altemier手术加或不加提肛肌成形术的复发率较低，但复发率高于腹部手术。

除了会阴入路后的高复发率外，所有手术都不能彻底解决大多数病人的症状

PSP切除术于2008年由舍勒等人提出。作为一种新的会阴手术入路。作者报告手术时间短，中期功能良好。

由于尚未报告长期结果，本研究的目的是评估复发率、预后效果和发病率方面的长期结果。

Materials and methods

全层直肠外脱垂合并严重并发症的患者可采用会阴入路。

在这些人群中，出于可行性的考虑，在这些人群中，选择从肛门皮肤边缘测量的全层直肠外脱垂5cm的患者进行PSP切除术。

所有患者术前均接受灌肠、预防性应用抗生素。

根据病人的喜好使用脊麻或全身麻醉。

患者取头低脚高截石位。

手术由相同的外科医生使用标准化技术进行。

脱垂在3点和9点被脱出并沿肠轴用直线闭合器打开。随后，水平完成脱垂的切除。

全脱垂切除术是通过一个连续的，逆时针的横向切除进行的，前侧从3点钟开始，后侧从9点钟开始，使用弧形切割闭合器 。

订合的位置与齿状线平行。在完全切除后，新的直肠和肛门粘膜自发地重新定位到正确的解剖位置。为达到止血效果，放置可吸收单丝缝合线。

Results

包括所有因外部直肠脱垂而行PSP切除术的9例患者（8例女性和1例男性）。

中位年龄为72岁（25-88岁）。

术前脱垂的中位长度为7.5cm（范围5-9cm）。中位手术时间为60分钟（范围30-75分钟），中位住院时间为5天（3-13天）。

术中无并发症发生。一位病人术后出现盆腔脓肿，并成功地接受抗生素和经皮引流治疗。

共有3名病人因新诊断的尿路感染而在术后接受抗生素治疗。

本研究中无手术相关死亡率。

术后6个月，有2例患者在术前发现了大便失禁，其中1例恶化了。另一例患者出现了新发的大便失禁。

平均随访40个月，9患者复发4人。

复发的中位时间8个月。

其中2例采用Delorme手术治疗，

1例腹腔镜下直肠固定术，

1例通开腹手术并抬高道格拉斯窝。

Discussion

这是对PSP切除直肠脱垂的长期结果的首次研究。该手术有较少的并发症，没有死亡率和效果较微弱，长期复发率为44％。

在材料成本方面，PSP切除比Delorme或altemier手术更昂贵。

然而，当考虑到与其他肛周手术相比，PSP患者的手术时间缩短，住院时间缩短，更高的费用可能会得到补偿。

Delorme手术和Altemeier手术是低风险技术，复发率高达32％。

与会阴方法相比，腹部入路的复发率较低，但是并发症率和死亡率较高，并且恢复期更长。

在我们研究中发现，多种原因导致复发率高。

结果不佳的一个解释可能是盆底功能不全和缺乏提肛肌成形术。未做提肛肌成形术的Altemier手术显示复发率高达58%。然而，与提肛肌成形术相结合会导致复发率显著降低至0%。

结合提肛肌成形术在PSP切除术中可能获得类似的结果。另外，学习曲线可以解释我们研究中的高复发率。

我们研究的患者中位脱垂长度为7.5厘米，比其他研究中报道的更长。这表明骨盆底功能障碍更为严重。

最近在一项共识调查中发表的建议指出，对于选定的患者，尤其是对于预期寿命较短的老年和多疾病病患者，PSP切除术可能是一种外科手术选择。这些建议与我们的结果一致，即长期发病率低，但复发率高。

psp切除术是治疗直肠外脱垂的安全方法。它允许切除脱垂的直肠而不需要移动或解剖直肠。但远期复发率高达44%。

目前，PSP可被视为高龄和体弱、合并严重疾病、预期寿命短的患者的手术选择。在将PSP引入临床常规应用之前，还需要对更大的系列进行进一步的研究。

原文

perineal stapled(钉合) prolapse resection（切除术） for external rectal prolapse:is it worthwhile（值得的） in the long-term?

Abstract

Perineal stapled prolapse (PSP) resection is a novel operation for treating external rectal prolapse.

However, no long-term results have been reported in the literature. This study analyses the long-term recurrence rate, functional outcome, and morbidity associated with PSP resection.

Nine consecutive patients undergoing PSP resection between 2007 and 2011 were prospectively followed.

Surgery was performed by the same surgeons in a standardised technique。

Recurrence rate, functional outcome, and complication grade were prospectively assessed.

All 9 patients undergoing PSP resection wereInvestigated. The median age was 72 years

No intraoperative complications occurred。

Faecal incontinence, preoperatively present in 2 patients,worsened postoperatively in one patient .

One patient developed new-onset faecal incontinence

The median obstructive defecation syndrome

score decreased postoperatively significantly from 11 to 5

At a median follow-up of 40 months,

the prolapse recurrence rate was 44 %

The PSP resection is a fast and safe procedure associated with low morbidity. However, the poor long-term functional outcome and the recurrence rate of 44 % warrant a cautious patient selection.

Introduction

The perineal approach is considered a surgical strategyfor elderly and polymorbid patients because it is associated with low morbidity .

The Rehn-Delorme and Altemeier procedures are the two most commonly performed perineal techniques.

As compared to abdominal techniques,

perineal approaches are burdened with majorshortcomings such as less improvement of continence and increased recurrence rates

Altemeier’s procedure, with or without levatorplasty, is associated with lower recurrence rates than Delorme’s procedure, but higher recurrence rates than abdominal approaches .

Beside the overall high recurrence rate after perineal approaches, none of these procedures provides complete resolution of symptoms in the majority of patients。

Perineal stapled prolapse (PSP) resection was introduced in 2008 by Scherer et al. as a new perineal surgical approach. The authors reported a short operating time and good mid-term functional results.

Since no long-term results have yet been reported, the aim of this study was to assess long-term results with regard to recurrence rate,functional outcome, and morbidity.

Materials and methods

Patients with a full-thickness external rectal prolapse and significant comorbidities were offered a perineal approach.

Out of this population, for feasibility reasons, patients with a full-thickness external rectal prolapse 5 cm, measured from the anocutaneous verge, were selected for PSP resection.

All patients receivedan enema preoperatively and antibiotic prophylaxis

Spinal anaesthesia or general anaesthesia was used according to the patient’s preference.

Patients were placed in the lithotomy position in Trendelenburg

Surgery was performed by the same surgeons using a standardised technique

The prolapse was pulled out completely and opened with a linear stapler by two axial transections at 3 and 9 o’clock

Subsequently, the horizontal prolapse resection was completed.

The complete prolapse resection was performed via a continuous, counter clockwise transection beginning anteriorly at 3 o’clock and posteriorly at 9 o’clock using the curved Contour Transtar stapler.

The stapler was positioned parallel to the dentate line. After the complete resection, neorectum and anal mucosa relocated spontaneously to their correct anatomical position.To achieve haemostasis,absorbable monofilament sutures were placed。

Results

All 9 patients (8 females and 1 male) undergoing PSP resection for external rectal prolapse were included.

Median age was 72 years (range 25–88 years).The median preoperative length of the prolapse was 7.5 cm (range5–9 cm). Median operating time was 60 min (range30–75 min), and median hospital stay was 5 days (range3–13 days)

No intraoperative complications occurred. One patient developed a pelvic abscess postoperatively and was successfully treated with antibiotics and percutaneous drainage.

A total of 3 patients received antibiotics postoperatively due to a newly diagnosed urinary tract infection.There was no procedure-related mortality in this study.

At 6 months after surgery, faecal incontinence, preoperatively noticed in 2 patients, had worsened in one patient。Another patient developed new-onset faecal incontinence .

At a median follow-up of 40 months, rectal prolapse recurred in 4 of 9 patients

Recurrence was observed at a median time of 8 months。

and treatment consisted of Delorme’s procedure in 2 cases,1 laparoscopic rectopexy and 1 open rectopexy with Douglas obliteration.

Discussion

This is the first study of the long-term results of PSP resection for external rectal prolapse. The procedure was associated with low morbidity, no mortality, and marginal functional results. However, the long-term recurrence rate of 44 % was high.

Regarding material costs, PSP resection is more expensive than Delorme’s or Altemeier’s procedure.

However, when taking into account the decreased operating time as well as the reduced length of hospital stay in PSP patients compared to those who underwent other perianal procedures, the higher costs might be compensated.

The Rehn-Delorme operation and Altemeier procedure are low-risk techniques associated with high recurrence rates reaching 32 %

Delorme手术和Altemeier手术是低风险技术，复发率高达32％。

Abdominal approaches are associated with lower recurrence rates than to perineal approaches but with higher rates of morbidity and mortality and with longer reconvalescence

Multiple reasons might lead to the high recurrence rate in our study.

A possible explanation for the poor results might be insufficiency of the pelvic floor and the lack of levatorplasty. Altemeier’s procedure without levatorplasty shows recurrence rates in up to 58 %。whereas a combination with levatorplasty results in a significant reduction in the recurrence rate of 0 %

Similar results might be obtained in PSP resection when combining with levatorplasty. Additionally, a learning curve may explain the high recurrence rate in our study.

The patients in our study showed a median prolapse length of 7.5 cm,which is longer than reported in other studies. This suggests a more advanced pelvic floor dysfunction.

The recommendations published recently in a consensus survey state that PSP resection is a possible surgical option for selected patients, especially for elderly and polymorbid patients with a short life expectancy. These recommendations are in line with our results yielding low morbidity but a high recurrence rate in the longer term

psp resection is a safe procedure for the treatment of external rectal prolapse. It permits resection of the prolapsed rectum without need of mobilisation or dissection of the rectum. However, the long-term,recurrence rate of 44 % was high.

Currently, PSP can be regarded as a surgical option for older and frail patients with severe comorbidities and a short life expectancy.Further studies on larger series are required prior to the introduction of PSP for routine use in clinical practice

没了。今晚夜班随便发的。