Rectocele: Incidental or important? Observe or operate? Contemporary diagnosis and management in the multidisciplinary era.
Rectocele: Incidental or important? Observe or operate? Contemporary diagnosis and management in the multidisciplinary era.
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直肠前突：偶然还是重要？观察还是操作？多学科时代的当代诊断和管理。
DOI：
10.1111/nmo.14453
复制
发表时间：
2022-11
影响因子：
3.5
通讯作者：
Knowles, Charles H.
中科院分区：
文献类型：
--
作者：
Bharucha, Adil E.;Knowles, Charles H.
直肠膨出在老年妇女中比年轻妇女更常见，可能继发于盆底无力和/或盆底功能障碍伴直肠排泄受损。直肠突可小（< 2厘米）、中（2 - 4厘米）或大（4 - 4厘米）。可以说，大的直肠突更可能与症状（如排便困难）有关。确定直肠膨出在多大程度上继发于盆底功能障碍和/或是否是直肠膨出而不是相关的盆底功能障碍导致了这些症状，这是具有挑战性的。当最初的治疗措施（如肠道调节剂和盆底生物反馈疗法）不成功时，应考虑手术修复。我们总结了直肠突的临床特征、诊断和治疗，重点是手术修复后的结果。本综述回顾性分析了英国一家大型教学医院3名结直肠外科医生对215名患者进行多学科经阴道直肠膨出修复手术后的结果。大多数患者有较大的直肠前突。一些患者还接受了前提肛成形术和/或肠膨出修复术。所有患者均接受联合评估，部分患者接受结直肠和泌尿妇科外科医生的手术。在该队列中，围手术期数据、疗效和危害结局与主要来自回顾性系列的历史数据相当，其中患者预后良好（67% - 78%），排便困难症状改善（30% - 50%），患者术后2年复发直肠前突（17%）。基于这些数据，有必要进行前瞻性研究，严格评估手术修复后的结果。
More common in older women than younger women, rectoceles may be secondary to pelvic floor weakness and/or pelvic floor dysfunction with impaired rectal evacuation. Rectoceles may be small (< 2 cm), medium (2–4 cm), or large (> 4 cm). Arguably, large rectoceles are more likely to be associated with symptoms (eg, difficult defecation). It can be challenging to ascertain the extent to which a rectocele is secondary to pelvic floor dysfunction and/or whether a rectocele, rather than associated pelvic floor dysfunction, is responsible for symptoms. Surgical repair should be considered when initial treatment measures (eg, bowel modifying agents and pelvic floor biofeedback therapy) are unsuccessful. We summarize the clinical features, diagnosis, and management of rectoceles, with an emphasis on outcomes after surgical repair. This review accompanies a retrospective analysis of outcomes after multidisciplinary, transvaginal rectocele repair procedures undertaken by 3 colorectal surgeons in 215 patients at a large teaching hospital in the UK. A majority of patients had a large rectocele. Some patients also underwent an anterior levatorplasty and/or an enterocele repair. All patients were jointly assessed, and some patients underwent surgery by colorectal and urogynecologic surgeons. In this cohort, the perioperative data, efficacy, and harms outcomes are comparable to historical data predominantly derived from retrospective series in which patients had a good outcome (67%−78%), symptoms of difficult defecation improved (30%−50%), and patients had a recurrent rectocele 2 years after surgery (17%). Building on these data, prospective studies that rigorously evaluate outcomes after surgical repair are necessary.
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DOI：
10.1186/s12905-021-01304-6
发表时间：
2021-04-20
期刊：
BMC women's health
影响因子：
--
作者：
Tan C;Tan M;Geng J;Tang J;Yang X
通讯作者：
Yang X
影响因子：
1.8
作者：
Durnea, C. M.;Khashan, A. S.;O'Reilly, B. A.
通讯作者：
O'Reilly, B. A.
影响因子：
9.8
作者：
Bharucha, Adil E.;Seide, Barbara M.;Melton, L. Joseph, III
通讯作者：
Melton, L. Joseph, III
影响因子：
29.4
作者：
Bharucha, AE;Fletcher, JG;Zinsmeister, AR
通讯作者：
Zinsmeister, AR
影响因子：
2.8
作者：
Carter, Dan;Gabel, Marc Beer
通讯作者：
Gabel, Marc Beer