남성 직장탈 환자의 임상특성, 항문직장생리검사 소견 및 술식의 선택에 대한 고찰
Clinical and Physiologic Characteristics of Rectal Prolapse in Males
윤서구, 이광렬, 조경아, 황도연, 김건욱, 강용원, 박원갑, 김현식, 이종균, 김광연,
소속 상세정보
윤서구 ( Yoon Seo-Gu )
송도병원 외과
이광렬 ( Lee Kwang-Ryul )
송도병원 외과
조경아 ( Jo Kyung-Ah )
송도병원 외과
황도연 ( Hwang Do-Yeon )
송도병원 외과
김건욱 ( Kim Khun-Uk )
송도병원 외과
강용원 ( Kang Yong-Won )
송도병원 외과
박원갑 ( Park Won-Kap )
송도병원 외과
김현식 ( Kim Hyun-Sik )
송도병원 외과
이종균 ( Lee Jong-Kyun )
송도병원 외과
김광연 ( Kim Kwang-Yeon )
송도병원 외과
KMID : 0356720000160040223
Abstract
Purpose: This study compares the sexual differences among rectal prolapse patients regarding the clinical and the physiologic characteristics with emphasis on males.
Methods: The clinical data, functional status and operative records of 43 patients, who had completed both clinical and functional evaluations were collected in a prospective database and were analyzed according to sex. The functional status of the patients was evaluated by Wexner’s constipation score (0∼30), Wexner’s incontinence score (0∼20), anorectal manometry, and pudendal nerve terminal motor latency (PNTML).
Results: The incidences of rectal prolapse in males (n=22) and in females (n=21) were similar. The age of onset for males was lower (mean standard deviation, 19.6 19.59 (50% in childhood) vs 52.0 20.75 years; p=0.001) and the duration of symptoms was longer (31.5 19.87 vs 12.5 14.31 years; p＜0.001). Surgery in males was most commonly performed during the sexually active years (51.2 16.34 vs 64.5 13.19; p=0.006). The incidence of mucosal prolapse in males was higher (10/22 vs 4/17; p=0.065). The incidences and the severities of defecation difficulty in males and females were
similar (n=12, mean Wexner score=8.4 vs n=12, mean Wexner score=9.9; p=NS) but, the incidences and the severities of fecal incontinence were lower in males (n=4, mean Wexner score=4.3 vs n=17, mean Wexner score= 14.2; p＜0.001). The maximum resting pressure was higher in males (39.2 21.46 vs 26.3 19.98 mmHg; p=0.049), and the maximum squeezing
pressure was better preserved (131.2 62.63 vs 67.5 37.99 mmHg; p＜0.001). No significant difference existed in the PNTML. Female patients underwent abdominal resection rectopexy (n=6), perineal rectosigmoidectomy with lavatoroplasty (n=11), and Delorme’s procedure (n=4), but all male patients preferred the perineal approach (rectosigmoidectomy with
lavatoroplasty (n=8), Delorme’s procedure (n=14)) for fear of sexual dysfunction after the abdominal approach.
Conclusion: These findings suggest that the mechanism for developing rectal prolapse in male and female may be different and that surgical treatment should be tailored to the patient.
키워드
직장탈;남성;변실금;변비;수술
Rectal prolapse;Male;Fecal incontinence;Constipation;Surgery
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