直肠脱垂外科诊疗现状与进展
Current Status and Progress in the Surgical Diagnosis and Treatment of Rectal Prolapse
DOI: 10.12677/ACM.2024.143661, PDF,    科研立项经费支持
作者: 曹 聪：宁夏医科大学临床医学院，宁夏 银川；甘肃省人民医院肛肠科，甘肃 兰州；甘肃省肛肠疾病临床医学研究中心，甘肃 兰州；胡东平, 杨熊飞*：甘肃省人民医院肛肠科，甘肃 兰州；甘肃省肛肠疾病临床医学研究中心，甘肃 兰州
关键词: 直肠脱垂；外科治疗；微创；Rectal Prolapse； Surgical Treatment； Microtrauma
摘要: 直肠脱垂是指直肠黏膜或全层，甚至乙状结肠或肛管向下移位的一种疾病，中医称为“脱肛”。直肠脱垂发病率约为0.5%，以儿童和老年人多见。儿童随着骶骨的发育有自愈倾向；中青年患者以男性为著，多为幼儿时期疾病未愈发展而来；老年患者以女性常见。脱出物引起黏液渗出、出血及排便异常等，严重影响患者的生活质量，而外科手术是唯一可能治愈直肠脱垂的方法。然而，目前对于直肠脱垂的最佳手术方式仍存在争议。本文将对直肠脱垂的各种手术方式予以综述，为临床手术方式的选择提供一定的参考价值。
Abstract: Rectal prolapse refers to a disease in which the rectal mucosa or the whole layer, or even the sig-moid colon or the anal canal is shifted downward. It is called “prolapsed” in traditional Chinese medicine. The incidence of rectal prolapse is about 0.5%, which is more common in children and the elderly. Children have a tendency to self-healing with the development of the sacrum. Young and middle-aged patients are mainly male, mostly from the unhealed development of diseases in early childhood. Elderly patients are common in women. Exudate causes mucus exudation, bleeding and abnormal defecation, seriously affecting the quality of life of patients. Surgery is the only possible way to cure rectal prolapse. However, the best surgical method for rectal prolapse is still controver-sial. This article will review the various surgical methods of rectal prolapse, and provide some ref-erence value for the selection of clinical surgical methods.
文章引用：曹聪, 胡东平, 杨熊飞. 直肠脱垂外科诊疗现状与进展[J]. 临床医学进展, 2024, 14(3): 28-36. https://doi.org/10.12677/ACM.2024.143661

参考文献

[1] Steele, S.R., Varam, M.G., Prichard, D., et al. (2015) The Evolution of Evaluation and Management of Urinary or Fecal Incontinence and Pelvic Organ Prolapse. Current Problems in Surgery, 52, 92-136. [Google Scholar] [CrossRef] [PubMed]
[2] Lowery, A.C., Simmang, C.L., Boulos, P., et al. (2001) Con-sensus Statement of Definitions for Anorectal Physiology and Rectal Cancer: Report of the Tripartite Consensus Confer-ence on Definitions for Anorectal Physiology and Rectal Cancer, Washington, D.C., May 1, 1999. Diseases of the Colon and Rectum, 44, 915-919. [Google Scholar] [CrossRef] 
[3] Bordeianou, L., Hicks, C.W., Kaiser, A.M., et al. (2014) Rectal Prolapse: An Overview of Clinical Features, Diagnosis, and Patient-Specific Management Strategies. Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract, 18, 1059-1069. [Google Scholar] [CrossRef] [PubMed]
[4] Liliana, B., Ian, P., Eric, J., et al. (2017) Clinical Practice Guide-lines for the Treatment of Rectal Prolapse. Diseases of the Colon & Rectum, 60, 1121-1131. [Google Scholar] [CrossRef] 
[5] Formijne, J.H.A., Draaisma, W.A., Wexner, S.D., et al. (2013) Evaluation and Surgical Treatment of Rectal Prolapse: An International Survey. Colorectal Disease: The Official Journal of the Association of Coloproctology of Great Britain and Ireland, 15, 115-119. [Google Scholar] [CrossRef] [PubMed]
[6] Melton, G.B. and Kwaan, M.R. (2013) The Surgical Clin-ics of North America. Rectal Prolapse, 93, 187-198. [Google Scholar] [CrossRef] [PubMed]
[7] Hatch, Q. and Steele, S.R. (2013) Gastroenterology Clinics of North America. Rectal Prolapse and Intussusception, 42, 837-861. [Google Scholar] [CrossRef] [PubMed]
[8] Karulf, R.E., Madoff, R.D. and Goldberg, S.M. (2001) Current Problems in Surgery. Rectal Prolapse, 38, 771-832. [Google Scholar] [CrossRef] 
[9] Carioude, V.L., Venara, A., Duchalais, E., et al. (2017) In-ternal Rectal Prolapse: Definition, Assessment and Management in 2016. Journal of Visceral Surgery, 154, 21-28. [Google Scholar] [CrossRef] [PubMed]
[10] Van, I.J.J., Paulides, T.J., Verheijen, P.M., et al. (2016) Cur-rent Status of Laparoscopic and Robotic Ventral Mesh Rectopexy for External and Internal Rectal Prolapse. World Jour-nal of Gastroenterology, 22, 4977-4987. [Google Scholar] [CrossRef] [PubMed]
[11] Gachabayov, M., Bendl, R., Flusberg, M., et al. (2021) Rectal Pro-lapse and Pelvic Descent. Current Problems in Surgery, 58, Article ID: 100952. [Google Scholar] [CrossRef] [PubMed]
[12] Anderson, D.E. and Miesner, M.D. (2008) The Veterinary Clinics of North America Food Animal Practice. Rectal Prolapse, 24, 403-408. [Google Scholar] [CrossRef] [PubMed]
[13] Senapati, A., Gray, R.G., Middleton, L.J., et al. (2013) PROSPER: A Randomised Comparison of Surgical Treatments for Rectal Prolapse. Colorectal Disease: The Official Journal of the Association of Coloproctology of Great Britain and Ireland, 15, 858-868. [Google Scholar] [CrossRef] [PubMed]
[14] Elmalik, K., Dagash, H. and Shawis, R.N. (2009) Abdominal Posterior Rectopexy with an Omental Pedicle for Intractable Rectal Prolapse: A Modified Technique. Pediatric Surgery Interna-tional, 25, 719-722. [Google Scholar] [CrossRef] [PubMed]
[15] Gunner, C.K., Senapati, A., Northover, J.M., et al. (2016) Life after PROSPER. What Do People Do for External Rectal Prolapse. Colorectal Disease: The Official Journal of the Asso-ciation of Coloproctology of Great Britain and Ireland, 18, 811-814. [Google Scholar] [CrossRef] [PubMed]
[16] Senapati, A., Nicholls, R.J., Thomson, J.P., et al. (1994) Results of De-lorme’s Procedure for Rectal Prolapse. Diseases of the Colon and Rectum, 37, 456-460. [Google Scholar] [CrossRef] 
[17] Blaker, K. and Anandam, J.L. (2017) Functional Disorders: Rectoanal Intussusception. Clinics in Colon and Rectal Surgery, 30, 5-11. [Google Scholar] [CrossRef] [PubMed]
[18] Albertsdottir, E. and Qvist, N. (2018) Postoperative Complications and Long-Term Functional Outcome in Children Operated for Idiopathic Rectal Prolapse. Pediatric Surgery International, 34, 85-89. [Google Scholar] [CrossRef] [PubMed]
[19] Raahave, D., Jensen, A.K., Dammegaard, L., et al. (2016) Primary and Repeated Perineal Stapled Prolapse Resection. Techniques in Coloproctology, 20, 853-857. [Google Scholar] [CrossRef] [PubMed]
[20] Faugeroux, V., Ahmed, O. and Tresallet, C. (2021) Altemeier Procedure for Surgical Treatment of Full Thickness External Rectal Prolapse (with Video). Journal of Visceral Surgery, 158, 530-531. [Google Scholar] [CrossRef] [PubMed]
[21] Hora, J.A. and Nahas, S.C. (2023) Altemeier’s Procedure for Full-Thickness Rectal Prolapse. Diseases of the Colon and Rectum, 66, E1133. [Google Scholar] [CrossRef] 
[22] Riansuwan, W., Hull, T.L., Bast, J., et al. (2010) Compari-son of Perineal Operations with Abdominal Operations for Full-Thickness Rectal Prolapse. World Journal of Surgery, 34, 1116-1122. [Google Scholar] [CrossRef] [PubMed]
[23] Pinheiro, L.V., Leal, R.F., Coy, C.S., et al. (2016) Long-Term Outcome of Perineal Rectosigmoidectomy for Rectal Prolapse. International Journal of Surgery (London, England), 32, 78-82. [Google Scholar] [CrossRef] [PubMed]
[24] Eftaiha, S.M., Calata, J.F., Sugrue, J.J., et al. (2017) Bio-Thiersch as an Adjunct to Perineal Proctectomy Reduces Rates of Recurrent Rectal Prolapse. Diseases of the Colon and Rectum, 60, 187-193. [Google Scholar] [CrossRef] 
[25] Scherer, R., Marti, L. and Hetzer, F.H. (2008) Perineal Sta-pled Prolapse Resection: A New Procedure for External Rectal Prolapse. Diseases of the Colon and Rectum, 51, 1727-1730. [Google Scholar] [CrossRef] [PubMed]
[26] Forster, C.E., Fuglistaler, I. and Steinemann, D.C. (2018) Intraoperative Check for Enterocele in Perineal Stapled Prolapse Resection. Techniques in Coloproctology, 22, 389-391. [Google Scholar] [CrossRef] [PubMed]
[27] Emile, S.H., Elfeki, H., Shalaby, M., et al. (2017) Peri-neal Resectional Procedures for the Treatment of Complete Rectal Prolapse: A Systematic Review of the Literature. In-ternational Journal of Surgery (London, England), 46, 146-154. [Google Scholar] [CrossRef] [PubMed]
[28] Thiersch, C. and Carl, T. (1988) Concerning Prolapse of the Rectum with Special Emphasis on the Operation by Thiersch. Diseases of the Colon and Rectum, 31, 154-155. [Google Scholar] [CrossRef] 
[29] Yamana, T. and Iwadare, J. (2003) Mucosal Plication (Gant-Miwa Pro-cedure) with Anal Encircling for Rectal Prolapse—A Review of the Japanese Experience. Diseases of the Colon and Rectum, 46, S94-S99.
[30] Iida, Y., Honda, K., Saitou, H., et al. (2019) Modified Gant-Miwa-Thiersch Procedure (Mucosal Plication with Anal Encircling) for Rectal Prolapse. Colorectal Disease: The Official Journal of the Association of Coloproctology of Great Britain and Ireland, 21, 588-594. [Google Scholar] [CrossRef] [PubMed]
[31] Berman, I.R. (1992) Sutureless Laparoscopic Rectopexy for Procidentia. Technique and Implications. Diseases of the Colon and Rec-tum, 35, 689-693. [Google Scholar] [CrossRef] 
[32] Smedberg, J., Graf, W., Pekkari, K., et al. (2022) Comparison of Four Surgical Approaches for Rectal Prolapse: Multicentre Randomized Clinical Trial. BJS Open, 6, Zrab 140. [Google Scholar] [CrossRef] [PubMed]
[33] Emile, S.H., Youssef, M., Thabet, W., et al. (2017) Laparoscop-ic Ventral Mesh Rectopexy vs Delorme’s Operation in Management of Complete Rectal Prolapse: A Prospective Ran-domized Study. Colorectal Disease: The Official Journal of the Association of Coloproctology of Great Britain and Ire-land, 19, 50-57. [Google Scholar] [CrossRef] [PubMed]
[34] Dhoore, A., Cadoni, R. and Penninckx, F. (2004) Long-Term Outcome of Laparoscopic Ventral Rectopexy for Total Rectal Prolapse. The British Journal of Surgery, 91, 1500-1555. [Google Scholar] [CrossRef] [PubMed]
[35] Novell, J.R., Osborne, M.J., Winslet, M.C., et al. (1994) Pro-spective Randomized Trial of Ivalon Sponge versus Sutured Rectopexy for Full-Thickness Rectal Prolapse. The British Journal of Surgery, 81, 904-906. [Google Scholar] [CrossRef] [PubMed]
[36] Matsuda, Y., Nishikawa, M., Nishizawaa, S., et al. (2019) Clinical Outcome and Surgical Technique of Laparoscopic Posterior Rectopexy Using the Mesh with Anti-Adhesion Coating. Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 29, E41-E44. [Google Scholar] [CrossRef] 
[37] Ripstein, C.B. (1952) Treatment of Massive Rectal Prolapse. American Journal of Surgery, 83, 68-71. [Google Scholar] [CrossRef] 
[38] Roberts, P.L., Schoetz, D.J., Coller, J.A., et al. (1988) Rip-stein Procedure. Lahey Clinic Experience: 1963-1985. Archives of Surgery (Chicago, Ill: 1960), 123, 554-557. [Google Scholar] [CrossRef] [PubMed]
[39] Ceci, F., Spaziani, E., Corelli, S., et al. (2013) Tech-nique and Outcomes about a New Laparoscopic Procedure: The Pelvic Organ Prolapse Suspension (POPS). Il Giornale Di Chirurgia, 34, 141-144. [Google Scholar] [CrossRef] [PubMed]
[40] Farag, A., Mashhour, A.N., Raslan, M., et al. (2020) Laparo-scopic Pelvic Organ Prolapse Suspension (Pops) versus Laparoscopic Ventral Mesh Rectopexy for Treatment of Rectal Prolapse: Prospective Cohort Study. World Journal of Surgery, 44, 3158-3166. [Google Scholar] [CrossRef] [PubMed]
[41] Geomini, P.M., Brolmann, H.A., Van Binsbergen, N.J., et al. (2001) Vaginal Vault Suspension by Abdominal Sacral Colpopexy for Prolapse: A Follow up Study of 40 Patients. Eu-ropean Journal of Obstetrics, Gynecology, and Reproductive Biology, 94, 234-238. [Google Scholar] [CrossRef] 
[42] Frykman, H.M. (1955) Abdominal Proctopexy and Primary Sigmoid Resection for Rectal Procidentia. American Journal of Surgery, 90, 780-789. [Google Scholar] [CrossRef] [PubMed]
[43] Varma, M., Rafferty, J. and Buie, W.D. (2011) Practice Pa-rameters for the Management of Rectal Prolapse. Diseases of the Colon and Rectum, 54, 1339-1346. [Google Scholar] [CrossRef] 
[44] Tsunoda, A. (2020) Surgical Treatment of Rectal Prolapse in the Laparoscopic Era; a Review of the Literature. Journal of the Anus, Rectum and Colon, 4, 89-99. [Google Scholar] [CrossRef] [PubMed]
[45] Loygue, J., Huguier, M., Malafosse, M., et al. (1971) Complete Pro-lapse of the Rectum. A Report on 140 Cases Treated by Rectopexy. The British Journal of Surgery, 58, 847-848. [Google Scholar] [CrossRef] [PubMed]
[46] Lechaux, D., Trebuchet, G., Siproudhis, L., et al. (2005) Laparoscopic Rectopexy for Full-Thickness Rectal Prolapse: A Single-Institution Retrospective Study Evaluating Surgical Outcome. Surgical Endoscopy, 19, 514-518. [Google Scholar] [CrossRef] [PubMed]
[47] Bjerke, T. and Mynster, T. (2014) Laparoscopic Ventral Rec-topexy in an Elderly Population with External Rectal Prolapse: Clinical and Anal Manometric Results. International Journal of Colorectal Disease, 29, 1257-1262. [Google Scholar] [CrossRef] [PubMed]
[48] Rondelli, F., Bugiantella, W., Villa, F., et al. (2014) Ro-bot-Assisted or Conventional Laparoscoic Rectopexy for Rectal Prolapse? Systematic Review and Meta-Analysis. Inter-national Journal of Surgery (London, England), 12, S153-S159. [Google Scholar] [CrossRef] [PubMed]
[49] Perrenot, C., Germain, A., Scherrer, M.L., et al. (2013) Long-Term Outcomes of Robot-Assisted Laparoscopic Rectopexy for Rectal Prolapse. Diseases of the Colon and Rectum, 56, 909-914. [Google Scholar] [CrossRef] 
[50] Chandra, A., Kumar, S., Rastogi, A., et al. (2019) Per Anal Endoscopic Rectopexy for Treatment of Complete Rectal Prolapse: A Preliminary Report. Indian Journal of Gastroen-terology: Official Journal of the Indian Society of Gastroenterology, 38, 542-549. [Google Scholar] [CrossRef] [PubMed]
[51] Chandra, A., Rajan, P., Gupta, V., et al. (2023) Natural Orifice Transanal Endoscopic Rectopexy for Complete Rectal Prolapse: Prospective Evolution of a New Technique and Short-Term Outcomes. Diseases of the Colon and Rectum, 66, 118-129. [Google Scholar] [CrossRef] 

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