改良 STARR 术治疗中重度直肠前突的疗效观察

Clinical research of improved STARR in the treatment of moderate and severe rectocele

目的：探讨改良 STARR 术治疗中重度直肠前突的临床疗效。方法选取中重度直肠前突患者70例，应用随机数字表法根据患者入院当日所在月份的奇偶随机分为对照组和观察组，对照组采用 Seha-payak 术治疗，观察组采用改良 STARR 术治疗。比较两组患者手术时间、术中出血量、术后疼痛评分、患者满意度、住院时间、复工时间等手术情况的差异；两组患者在术前、术后1周、1个月、3个月、6个月的 ODS 评分变化情况及临床疗效的差异；两组患者在术前、术后1个月及术后6个月行排粪造影，比较直肠前突改善情况。结果观察组患者的手术时间（29．76±8．40）min、术中出血量（14．43±8．16）mL、术后疼痛评分（4．29±1．76）分，均明显低于对照组手术时间（48．38±9．04）min、术中出血量（77．80±20．58）mL 及术后疼痛评分（4．29±1．76）分（t ＝8．934、16．935、5．338，均 P ＜0．05），观察组住院天数（6．71±1．22）d 及复工时间（7．20±1．36）d，均明显短于对照组[（11．23±3．64）d，（13．14±2．60）d（t ＝6．955、11．959，均 P ＜0．05），观察组患者对手术的满意度（8．83±0．98）分，高于对照组（7．54±1．20）分（t ＝4．908，P ＜0．05）。术后各随访时间点，两组患者的痊愈率、显效率及有效率的差异均无统计学意义（均 P ＞0．05）。观察组术前 ODS 评分为（20．97±4．38）分，术后1周为（4．71±1．30）分，术后1个月为（2．94±0．91）分，术后3个月为（1．68±1．04）分，术后6个月为（0．97±0．88）分；对照组术前为（19．88±4．09）分，术后依次为（4．65±1．28）分、（3．51±1．15）分、（2．88±1．67）分、（1．85±1．31）分，术后两组患者的 ODS 评分均较术前明显降低（t ＝20．666、23．904、26．127、26．401，均 P ＜0．05；t ＝22．882、24．081、24．032、25．015，均 P ＜0．05）；但术后1周时的两组 ODS 评分差异无统计学意义（P ＞0．05）；术后1个月、3个月、6个月时，两组的 ODS 评分差异均有统计学意义（t ＝2．313、3．585、3．233，均 P ＜0．05）。观察组术前直肠前突深度为（33．09±6．79）mm，术后1个月为（5．54±1．96）mm，术后6个月为（6．67±1．95）mm；对照组依次为（33．57±6．46）mm、（7．65±2．11）mm 及（9．32±2．74）mm。术前，两组患者直肠前突深度差异无统计学意义（P ＞0．05）；术后1个月及6个月，两组患者的直肠前突深度均较术前明显降低（t ＝21．779、20．646，均 P ＜0．05；t ＝25．261、20．768，均 P ＜0．05），且观察组较对照组降低更为明显（t ＝4．339、4．565，均 P ＜0．05）；两组患者在术后6个月时的直肠前突深度均较术后1个月时有所增加（t ＝2．864、3．113，均 P ＜0．05）。术后1周时，对照组的不良反应率为48．6％，观察组为22．9％，两组差异有统计学意义（χ2＝5．040，P ＝0．025）。术后6个月时，对照组不良反应率为8．1％，观察组为3．0％，两组差异无统计学意义（P ＞0．05）。结论改良 STARR 术治疗直肠前突具有疗效确切、操作简单、术后疼痛轻、住院时间短、患者满意度高等优点，且有利于预防直肠前突再次复发，是治疗直肠前突比较理想的方式。

Objective To study the therapeutic effect of improved STARR （Sehapayak as a control）in the treatment of moderate and severe rectocele.Methods 70 patients diagnosed with rectocele from Jan.2015 to Oct. 2015 were selected and randomly divided into 2 groups,35 cases in each group.They were treated with either improved STARR or Sehapayak surgery.The operation time,intraoperative blood loss,postoperative pain scores, patients＇satisfaction and hospitalization days were compared between 2 groups.The ODS scores and therapeutic effects were compared in 1st week,1st month,3rd month and 6th month after treatment.The defecography was implemented and compared between 2 groups before treatment and 1st week and 6th month after treatment.Results The operation time,intraoperative blood loss,postoperative pain scores,hospitalization days and time to return to work were signifi-cantly lower in STARR group than those in Sehapayak group[（29.76 ±8.40）min vs （48.38 ±9.04）min;（14.43 ± 8.16）mL vs （77.80 ±20.58）mL;（4.29 ±1.76）points vs （6.71 ±2.04）points;（6.71 ±1.22）d vs （11.23 ± 3.64）d;（7.20 ±1.36）d vs （13.14 ±2.60）d;t =8.934,16.935,5.338,6.955,11.959,all P 〈0.05],and the patients＇satisfaction was significantly higher in STARR group[（8.83 ±0.98）points vs （7.54 ±1.20）points,t =4.908,P 〈0.05].There were no significant differences in efficacy between 2 groups at any time point （P 〉0.05）. The ODS score was （20.97 ±4.38）points before treatment,（4.71 ±1.30）points 1week after treatment,（2.94 ± 0.91）points 1month later,（1.68 ±1.04）points 3months later and （0.97 ±0.88）points 6mons later in the observa-tion group.The ODS scores in the control group were （19.88 ±4.09）points,（4.65 ±1.28）points,（3.51 ±1.15） points,（2.88 ±1.67）points,（1.85 ±1.31）points,respectively.The postoperative ODS scores of the two groups of patients were compared with the preoperative decreased significantly （t =20.666,23.904,26.127,26.401,all P 〈0. 05;t =22.882,24.081,24.032,25.015,all P 〈0.05）,but at 1 week after operation of the two groups of ODS score had no statistically significant difference （P 〉0.05）;1 month,3 months and 6 months after surgery,the differences of ODS score of the two groups were statistically significant（t =2.313,3.585,323.3,all P 〈0.05）.The depth of recto-cele in the observation group was （33.09 ±6.79）mm before treatment,（5.54 ±1.96）mm 1month after treatment and （6.67 ±1.95 ）mm 6months after treatment;while （33.57 ±6.46）mm,（7.65 ±2.11 ）mm and （9.32 ± 2.74）mm in the control group,respectively.There was no difference between the two groups in the depth of rectocele before treatment （P 〉0.05）.After treatment,they were all significantly decreased （t =21.779,20.646,all P 〈0.05;t =25.261,20.768,all P 〈0.05）in the two groups,and compared with the control group,the observation group decreased more significantly（t =4.339,4.565,all P 〈0.05 ）.The two groups of patients at months after the 6th month of the rectal protrusion were significantly higher than the 1st months after the surgery （t =2.864,3.113,all P 〈0.05）.The incidence rate of side effects was significantly higher in STARR group than that in Sehapayak group 1st week after treatment （48.6% vs.22.9%,χ2 =5.040,P =0.025）,but there was no difference in 6th month after treatment （8.1% vs.3.0%,P 〉0.05）.Conclusion Compared with Sehapayak,improved STARR surgery has the advantage of excellent curative effects,less trauma,shorter hospitalization,less complications and higher patient satis-faction.Improved STARR surgery is conducive to the prevention of rectocele relapse.