经腹入路与经会阴入路手术治疗直肠脱垂的疗效及复发因素分析

Analysis of the Therapeutic Effects and Recurrence Factors of Transabdominal and Transperineal Approaches in the Surgical Treatment of Rectal Prolapse

摘要: 目的：探讨经腹与经会阴入路手术治疗直肠脱垂的疗效差异及复发影响因素，为临床个体化术式选择提供依据。方法：回顾性分析2015年1月至2024年1月本院93例直肠脱垂手术患者的临床资料，根据手术入路分为经腹组(35例)和经会阴组(58例)，比较两组围手术期指标、术后功能恢复及复发情况，采用单因素和多因素Logistic回归分析复发的相关因素。结果：经腹组手术时间、术中出血量及术后恢复时间均大于经会阴组(P < 0.05)，但复发率显著较低(2.90% vs 34.50%)，便秘改善及患者满意度更优(P < 0.05)。复发与未复发组在脱垂分度及手术方式上差异显著(P < 0.05)。单因素Logistic分析显示脱垂分度与手术方式为复发影响因素，多因素分析未发现独立危险因素。结论：经腹手术在降低复发率和改善功能方面优于经会阴手术，但创伤较大；经会阴手术恢复快而复发率较高。脱垂分度与手术方式为复发的重要考量因素，建议根据患者具体情况个体化选择术式。

Abstract: Objective: This paper aims to explore the differences in efficacy between transabdominal and transperineal approaches in the surgical treatment of rectal prolapse and the influencing factors of recurrence, providing a basis for individualized surgical approach selection in clinical practice. Methods: A retrospective analysis was conducted on the clinical data of 93 patients with rectal prolapse who underwent surgery in our hospital from January 2015 to January 2024. The patients were divided into the transabdominal group (35 cases) and the transperineal group (58 cases) based on the surgical approach. The perioperative indicators, postoperative functional recovery, and recurrence rates of the two groups were compared. Univariate and multivariate Logistic regression analyses were used to identify the factors related to recurrence. Results: The transabdominal group had longer operation time, greater intraoperative blood loss, and longer postoperative recovery time compared with the transperineal group (P < 0.05), but the recurrence rate was significantly lower (2.90% vs 34.50%), and the improvement of constipation and patient satisfaction were better (P < 0.05). There were significant differences in prolapse degree and surgical methods between the recurrence and non-recurrence groups (P < 0.05). Univariate Logistic analysis showed that prolapse degree and surgical method were factors influencing recurrence, but no independent risk factors were identified in the multivariate analysis. Conclusion: Transabdominal surgery is superior to transperineal surgery in reducing recurrence and improving function, but it is more invasive; transperineal surgery has a faster recovery but a higher recurrence rate. Prolapse degree and surgical method are important considerations for recurrence, and it is recommended to select the surgical approach based on the specific conditions of the patient.