经肛吻合器直肠切除术治疗出口梗阻型便秘的远期疗效

Long-term efficacy of stapled transanal rectal resection for obstructed defecation syndrome

目的评价经肛吻合器直肠切除术（STARR）治疗出口梗阻型便秘（ODS）的远期疗效。方法回顾性分析2010年2月至2012年8月期间火箭军总医院结直肠肛门外科采用STARR手术治疗95例女性ODS患者的临床资料．采用克利夫兰便秘评分（CSS）、LongoODS评分和症状严重程度评分（SSS）评价临床症状的程度及强度，患者满意度调查采用视觉模拟评分法（VAS）。定义术后12月时的临床症状评价为早期疗效，至随访终点（2016年8月）为远期疗效（≥48月）。结果全组95例患者，平均年龄54．5（29-79）岁，中位随访时间为65（48～78）月，术后分别有80例（84．2％）和44例（46．3％）完成早期和远期疗效评价。与术前基线水平比较，患者随访终点时CSS评分（14．69比6．02）、ODS评分（16．51比5．73）和SSS评分（14．64比5．14）均明显降低（均P〈O．01），VAS评分（3．96比7．20）明显升高（P〈0．01）。随访终点时ODS症状复发10例（22．7％）；满意度调查结果显示：非常满意10例（22．7％），满意17例（38．6％），比较满意9例（20．5％），不满意8例（18．2％）；治疗总体有效率为81．8％（36／44）。结论STARR治疗ODS远期疗效良好，但复发率相对较高。

Objective To evaluate the long-term efficacy of stapled transanal rectal resection （STARR） in treating obstructed defecation syndrome （ODS）. Methods Clinical data of 95 female patients with ODS undergoing STARR at Department of Colorectal Surgery, Rocket Army General Hospital from February 2010 to August 2012 were analyzed retrospectively. The Cleveland constipation scoring system （CSS）, Longo ODS scoring system and severe symptoms score （SSS） were used to evaluate the degree and intensity of clinical symptoms. Patient satisfaction was assessed by visual analogue scale （VAS）. Clinical symptoms at postoperative 12-month were defined as short-term efficacy, and at the end of follow up （ I〉48 months） were defined as long-term efficacy. Results The mean age was 54.5 （29 to 79） years and the median follow-up was 65 （48 to 78） months. Eighty （84.2%） and 44 （46.3%） patients completed the short-term and long-term efficacy evaluation respectively. At the end of follow up, compared with the baseline levels before operation, the CSS score （14.69 vs. 6.02）, ODS score （16.51 vs. 5.73） and SSS score （14.64 vs. 5.14） were significantly decreased （allP 〈 0.01）, but the VAS score （3.96 vs. 7.20, P〈 0.01） was significantly increased. A total of 10 patients （22.7%） developed symptomatic recurrence. The self-reported definitive satisfaction was excellent in 10 （22.7%） patients, fairly good in 17 （38.6%）, good in 9 （20.5%）, and poor in 8 （18.2%）. The total effective rate was 81.8%（36/44）. Conclusion Long-term efficacy of STARR in the treatment of ODS is good, but the rate of symptomatic recurrence is relatively high.