直腸脱に対する腹腔鏡下直腸固定術症例の直腸肛門機能

Anorectal function after laparoscopic rectopexy for rectal prolapse

◆要旨：[はじめに]直腸脱術後の直腸肛門機能に関する報告はほとんどない．本論文では直腸脱に対する腹腔鏡下直腸固定術前後の直腸肛門機能の変化を検討した．[対象および方法]1996～2006年までに腹腔鏡下直腸固定術（Well's法）を施行した12例を対象とし，直腸肛門内圧測定はマイクロトランスデューサー法にて施行した．術後の臨床的排便機能評価にはWexner's scoreおよび患者アンケートを用いた．[結果]腹腔鏡下直腸固定術後には，肛門管最大静止圧が有意に（P＝0.048）上昇した．その他の値は有意な変化を示さなかった．術後のWexner's scoreは有意に（P＝0.037）改善し，患者の満足度も高かった．[結語]腹腔鏡下直腸固定術後には，肛門管最大静止圧が有意に上昇し，臨床的な排便機能にも改善がみられた．

　Very few reports of anorectal functions after surgery have been documented in the literature. We report 12 patients with rectal prolapse who have undergone laparoscopic rectopexy（Well's procedure）from 1996 to 2006 in our institute.

Anorectal pressure of the patients was measured in t order to identify the changes in anorectal functions after laparoscopic rectopexy. Anorectal pressure was measured by microtransducer technique before and after the surgery. Wexner's score and a patient questionnaire for postoperative clinical evaluation of fecal function were used. A significant increase in the maximum resting pressure was observed after the laparoscopic rectopexy for prolapse, compared with the preoperative condition（P＝0.048）. No significant change was observed in other results. Postoperative Wexner's score improved significantly（P＝0.037）and the satisfaction of the patients was high. In conclusion, postoperative maximum resting pressure significantly increased, resulting in an improvement of anal function.