TRREMS procedure (transanal repair of rectocele and rectal mucosectomy with one circular stapler): a prospective multicenter trial
TRREMS procedure (transanal repair of rectocele and rectal mucosectomy with one circular stapler): a prospective multicenter trial
复制标题
DOI：
10.1590/s0004-28032011000100002
复制
发表时间：
2011-03-01
影响因子：
--
通讯作者：
Leal, Vilmar Moura
中科院分区：
文献类型：
--
作者：
Cruz, José Vinicius;Regadas, Francisco Sergio P.;Leal, Vilmar Moura
背景-由于肛门直肠膨出通常与粘膜脱垂和/或直肠肠套叠相关，因此开发了一种使用圆形吻合器的吻合器手术技术。目的-在一项前瞻性多中心试验中报告经肛门直肠前突修补术和使用一个环形吻合器进行直肠粘膜切除术（TRREMS手术）治疗直肠肛门前突伴粘膜脱垂的结果。方法：由14名外科医生进行，包括75名女性患者，平均年龄49.6岁，由于2级（26.7%）和3级（73.3%）肛门直肠前突伴粘膜脱垂和/或直肠肠套叠（52.0%）导致排便障碍症状，平均经验证的Wexner便秘评分为16。所有患者均通过直肠检查、排粪造影、肛门测压和结肠通过时间进行评估。TRREMS手术包括手动切除直肠膨出壁，并使用环形吻合器进行直肠粘膜环切术。平均随访时间为21个月。结果：所有患者均表现为排便障碍，经保守治疗后症状仍持续.平均手术时间42分钟。在13例（17.3%）患者中，吻合线出血需要止血缝合。2例（2.6%）吻合不完全。49例患者（65.3%）需要住院1天，其余患者（34.7%）需要住院2天。术后，3例（4.0%）患者主诉持续性直肠疼痛，7例（9.3%）吻合器缝线出现狭窄，随后通过麻醉下狭窄切除术（n = 1）、内镜下狭窄切除术（使用热活检钳）（n = 3）和指状扩张（n = 3）进行治疗。术后排粪造影显示8例（10.6%）残留I级直肠前突。平均Wexner便秘评分从16分下降到4分（0-4分：n = 68）（6分：n = 6）（7分：n = 1）（P
Context - Since anorectocele is usually associated with mucosa prolapse and/or rectal intussusceptions, it was developed a stapled surgical technique using one circular stapler. Objective - To report the results of Transanal Repair of Rectocele and Rectal Mucosectomy with one Circular Stapler (TRREMS procedure) in the treatment of anorectocele with mucosa prolapse in a prospective multicenter trial. Methods - It was conducted by 14 surgeons and included 75 female patients, mean aged 49.6 years, with symptoms of obstructed defecation due to grade 2 (26.7%) and grade 3 (73.3%) anorectocele associated with mucosa prolapse and/or rectal intussusception (52.0%) and an average validated Wexner constipation score of 16. All patients were evaluated by a proctological examination, cinedefecography, anal manometry and colonic transit time. The TRREMS procedure consists of the manual removal of the rectocele wall with circumferential rectal mucosectomy performed with a circular stapler. The mean follow-up time was 21 months. Results - All patients presented obstructed defecation and they persisted with symptoms despite conservative treatment. The mean operative time was 42 minutes. In 13 (17.3%) patients, bleeding from the stapled line required hemostatic suture. Stapling was incomplete in 2 (2.6%). Forty-nine patients (65.3%) required 1 hospitalization day, the remainder (34.7%) 2 days. Postoperatively, 3 (4.0%) patients complained of persistent rectal pain and 7 (9.3%) developed stricture on the stapled suture subsequently treated by stricturectomy under anesthesia (n = 1), endoscopic stricturectomy with hot biopsy forceps (n = 3) and digital dilatation (n = 3). Postoperative cinedefecography showed residual grade I anorectoceles in 8(10.6%). The mean Wexner constipation score decreased significantly from 16 to 4 (0-4: n = 68) (6: n = 6) (7: n = 1) (P