Abdominal rectopexy for the treatment of internal rectal prolapse: a systematic review and meta-analysis.
腹部直肠固定术治疗直肠内脱垂:系统回顾和荟萃分析
Abstract
AIM:
Internal rectal prolapse (IRP) is a unique functional disorder that presents with a wide spectrum of clinical symptoms, including constipation and/or faecal incontinence (FI). The present review aims to analyse the results of trials evaluating the role of abdominal rectopexy in the treatment of IRP with regard to regarding functional and technical outcomes.
目标:直肠内脱垂(IRP)是一种独特的功能性疾病,具有广泛的临床症状,包括便秘和/或大便失禁(FI)。本综述旨在分析试验功能上和技术上的结果以评估腹部直肠固定术在IRP治疗中的作用。
METHOD:
A systematic review of the literature for the role of abdominal rectopexy in patients with IRP was conducted. PubMed/Medline, Embase and the Cochrane Central Register of Controlled Trials were searched for published and unpublished studies from January 2000 to December 2015.
方法:对IRP患者腹部直肠固定作用的文献进行了系统评价。 检索于2000年1月至2015年12月期间在PubMed / Medline,Embase已发表和未发表的研究,和Cochrane对照试验中心登记册的试验。
RESULTS:
We reviewed 14 studies including 1301 patients (1180 women) of a median age of 59 years. The weighted mean rates of improvement of obstructed defaecation (OD) and FI across the studies were 73.9% and 60.2%, respectively. Twelve studies reported clinical recurrence in 84 (6.9%) patients. The weighted mean recurrence rate of IRP among the studies was 5.8% (95% CI: 4.2-7.5). Two hundred and thirty complications were reported with a weighted mean complication rate of 15%. Resection rectopexy had lower recurrence rates than did ventral rectopexy, whereas ventral rectopexy achieved better symptomatic improvement, a shorter operative time and a lower complication rate.
结果:我们回顾了14项研究,包括1301名患者(1180名女性),中位年龄为59岁。排便障碍(OD)和大便失禁的加权平均改善率分别为73.9%和60.2%。12项研究报告了84例(6.9%)患者的临床复发。研究中IRP的加权平均复发率为5.8%(95%CI:4.2-7.5)。报告了230例并发症,加权平均并发症发生率为15%。直肠切除固定术的复发率低于腹侧直肠固定术,而腹侧直肠固定术可得到更好的症状改善、手术时间更短、并发症发生率更低。
CONCLUSION:
Abdominal rectopexy for IRP attained satisfactory results with improvement of OD and, to a lesser extent, FI, a low incidence of recurrence and an acceptable morbidity rate. Although ventral rectopexy was associated with higher recurrence rates, lower complication rates and better improvement of bowel symptoms than resection rectopexy, these findings cannot be confirmed owing to the limitations of this review.
结论:用于IRP的腹部直肠固定术取得良好疗效,OD症状改善,并且在较小程度上,FI,复发率低和可接受的发病率。虽然同直肠切除术相比,腹侧直肠固定术的复发率较高,并发症发生率较低和肠道症状得到更好的改善,但由于本综述的局限性,这些发现无法得到证实。
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