STARR术治疗出口梗阻型便秘短期疗效观察及术后急便感作用靶点探讨

STARR in the Treatment of Outlet-obstructive Constipation:Short-term Effect Observation and Investigation for Postoperative Urge Defecation Target

为探讨经肛吻合器直肠切除术(STARR)治疗直肠黏膜内套叠引起的出口梗阻型便秘的短期疗效及术后急便感的可能作用靶点,回顾性分析89例行STARR术治疗的出口梗阻型便秘患者临床资料,评估手术前后Longo便秘评分及术后并发症情况。将术后出现急便感的患者与组内未出现急便感患者进行个体匹配(1∶1),检测患者直肠黏膜组织中TGF-β1含量差异。结果显示,与术前相比,术后6个月患者Longo便秘评分较术前明显改善(P<0.01);中位随访时间为(13.2±7.7)个月;1例术后半年内复发;6例出现不同程度急便感。个体匹配后,急便感组6例,无急便感组6例,急便感组TGF-β1的mRNA和蛋白表达水平均高于无急便感组。结果表明,STARR术治疗直肠内套叠引起的出口梗阻型便秘短期疗效可靠,并发症可控,是可供选择的手术方式。降低TGF-β1的表达可能是改善STARR术后急便感的作用靶点。

This study was to investigate the short-term effect of outlet-obstructive constipation(OOC)treated with stapled transanal rectal resection(STARR),and potential role target of postoperative urge defecation,reviewed 89cases'clinical data,evaluated their Longo score ratings on constipation before and after surgery,as well as postoperative complication status;and,matched the patients having postoperative urge defecation and the patients having no one(at 1∶1),to detect TGF-β1contents in rectal mucosa tissue.As results,compared to before surgery at 6months after surgery patients'Longo constipation ratings got significantly improved(P<0.01),their median follow-up time was(13.2±7.7)motnhs,1case surfferedfrom recurrence within 0.5years after surgery,6cases from urge defecation at different contents;after matching 6cases from urge defecation,6cases no urge defecation,in the TGF-β1mRNA and protein expression levels the former was higher than the latter.Results show that STARR's short-term effect is certain,and its complication could be controlled,thus the procedure could be selected.Also,reducing TGF-β1 expression could be the role-target of postoperative improving urge defecation.