[1]屈景辉**贺佳蓓①杨向东②.肛门括约肌成形术在直肠脱垂经会阴直肠乙状结肠切除术中的应用价值[J].中国微创外科杂志,2026,01(3):0.
　Qu Jinghui*,He Jiabei,Yang Xiangdong..Application Value of Anal Sphincteroplasty in Perineal Rectosigmoidectomy for Rectal Prolapse[J].Chinese Journal of Minimally Invasive Surgery,2026,01(3):0.
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肛门括约肌成形术在直肠脱垂经会阴直肠乙状结肠切除术中的应用价值()

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2026年3期
页码:
0
栏目:
临床研究
出版日期:
2026-03-26

文章信息/Info

Title:
Application Value of Anal Sphincteroplasty in Perineal Rectosigmoidectomy for Rectal Prolapse
作者:
屈景辉**贺佳蓓①杨向东②
(成都市中西医结合医院肛肠科，成都610041)
Author(s):
Qu Jinghui*;  He Jiabei;  Yang Xiangdong.
*Department of Colorectal Surgery, Chengdu Integrated TCM & Western Medicine Hospital, Chengdu 610041, China
关键词:
直肠脱垂; 肛门括约肌成形术; 经会阴直肠乙状结肠切除术
Keywords:
Rectal prolapse; Anal sphincteroplasty; Perineal rectosigmoidectomy
文献标志码:
A
摘要:
目的探讨肛门括约肌成形术在直肠脱垂经会阴直肠乙状结肠切除术中的应用价值。方法2020年11月~2023年11月我们采用肛门括约肌成形术联合经会阴直肠乙状结肠切除术治疗完全性直肠脱垂36例(成都肛肠专科医院24例，成都市中西医结合医院12例)，沿齿线上方1.5 cm处环形切开脱垂外层肠管，打开直肠子宫陷凹/直肠膀胱陷凹和盆底腹膜，游离保留直肠系膜后拉直脱垂的肠管，将盆底腹膜缝合固定于乙状结肠前壁，重建盆底。肛提肌折叠缝合后，离断乙状结肠并行端端吻合。最后经肛管后方“V”形切口暴露并折叠缝合肛门外括约肌，完成肛门括约肌成形术。结果36例顺利完成手术，手术时间(92±6)min，术中出血量(35±6)ml，术后住院时间(11.6±2.9)d。术后直肠脱垂症状均消失，无大出血、严重感染等并发症发生，无围手术期死亡。1例术后肛周切口局部脂肪液化，间断拆除2针缝线后加强换药，切口二期愈合。36例中位随访25(12，52)个月，无复发。与术前相比，术后3、12个月肛管静息压和收缩压均明显升高，且随时间呈上升趋势(均P=0.000)。与术前相比，术后12个月患者Wexner肛门失禁评分［2(0~6)分vs.14(4~18)分］显著降低 (Z=-3.086，P=0.023)。与术前相比，术后12个月患者Wexner便秘评分［2(0~8)分vs. 10(2~16)分］显著降低 (Z=-2.633，P=0031)。结论肛门括约肌成形术联合经会阴直肠乙状结肠切除术是治疗直肠脱垂的有效术式。
Abstract:
ObjectiveTo evaluate the application value of anal sphincteroplasty in perineal rectosigmoidectomy for rectal prolapse.MethodsFrom November 2020 to November 2023, 36 cases of complete rectal prolapse were treated by anal sphincteroplasty combined with perineal rectosigmoidectomy (24 cases at Chengdu Anorectal Specialized Hospital and 12 cases at Chengdu Integrated TCM & Western Medicine Hospital). The prolapsed outer bowel was cut circularly 1.5 cm above the tooth line, and the recto uterine depression/recto vesical depression and pelvic floor peritoneum were opened. The prolapsed bowel was straightened after free preservation of the mesorectum, and the pelvic floor peritoneum was sutured and fixed to the anterior wall of sigmoid colon to reconstruct the pelvic floor. After the levator ani muscle was folded and sutured, the sigmoid colon was severed and an endtoend anastomosis was performed. Finally, the anal sphincteroplasty was completed by exposing and folding the external anal sphincter through the "V" incision behind the anal canal.ResultsAll the operations of the 36 cases were successfully completed, with operation time of (92±6) min, intraoperative blood loss of (35±6) ml, and postoperative hospital stay of (11.6±2.9) d. All the patients experienced disappearance of symptoms of rectal prolapse after surgery, with no occurrence of complications such as major bleeding and severe infection. There was no perioperative death. One patient experienced local fat liquefaction at the perianal incision after surgery. Two stitches were intermittently removed and dressing changes were intensified, resulting in secondary wound healing. The median followup of 36 patients was 25 (12, 52) months, and there was no recurrence. Compared with preoperation, the anal resting pressure and systolic pressure increased significantly at 3 and 12 months after operation, and showed an upward trend with time (all P=0.000). The Wexner anal incontinence score of the patients was lower at 12 months after surgery than preoperation ［2 (0-6) points vs. 14 (4-18) points］, and the difference was statistically significant (Z=-3.086, P=0.023). The Wexner constipation score of the patients was lower at 12 months after surgery than preoperation ［2(0-8) points vs. 10(2-16) points］, and the difference was statistically significant (Z=-2.633, P=0.031).ConclusionThe combination of anal sphincteroplasty and perineal rectosigmoidectomy is an effective surgical approach for treating rectal prolapse.

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备注/Memo

备注/Memo:
基金项目：四川省中医药管理局中医药科研专项课题（2023MS089）**通讯作者，Email:qjh213@163.com①（四川省第五人民医院普外泌尿病区，成都610031）②（成都肛肠专科医院外科，成都 610015)
更新日期/Last Update: 2026-03-26