AIM:To prospectively assess the eff icacy and safety of stapled trans-anal rectal resection(STARR) compared to standard conservative treatment,and whether preoperative symptoms and findings at defecography and anorect...AIM:To prospectively assess the eff icacy and safety of stapled trans-anal rectal resection(STARR) compared to standard conservative treatment,and whether preoperative symptoms and findings at defecography and anorectal manometry can predict the outcome of STARR.METHODS:Thirty patients(Female,28;age:51 ± 9 years) with rectocele or rectal intussusception,a defecation disorder,and functional constipation were submitted for STARR.Thirty comparable patients(Female,30;age 53 ± 13 years),who presented with symptoms of rectocele or rectal intussusception and were treated with macrogol,were assessed.Patients were interviewed with a standardized questionnaire at study enrollment and 38 ± 18 mo after the STARR procedure or during macrogol treatment.A responder was def ined as an absence of the Rome Ⅲ diagnostic criteria for functional constipation.Defecography and rectoanal manometry were performed before and after the STARR procedure in 16 and 12 patients,respectively.RESULTS:After STARR,53% of patients were responders;during conservative treatment,75% were responders.After STARR,30% of the patients reported the use of laxatives,17% had intermittent anal pain,13% had anal leakage,13% required digital facilitation,6% experienced defecatory urgency,6% experienced fecal incontinence,and 6% required re-intervention.During macrogol therapy,23% of the patients complained of abdominal bloating and 13% of borborygmi,and 3% required digital facilitation.No preoperative symptom,defecographic,or manometric finding predicted the outcome of STARR.Post-operative defecography showed a statistically significant reduction(P < 0.05) of the rectal diameter and rectocele.The postoperative anorectal manometry showed that anal pressure and rectal sensitivity were not significantly modified,and that rectal compliance was reduced(P = 0.01).CONCLUSION:STARR is not better and is less safe than macrogol in the treatment of defecation disorders.It could be considered as an alternative therapy in patients unresponsive to macrogol.展开更多
The second part of the Consensus Statement of the Italian Association of Hospital Gastroenterologists and Italian Society of Colo-Rectal Surgery reports on the treatment of chronic constipation and obstructed defecati...The second part of the Consensus Statement of the Italian Association of Hospital Gastroenterologists and Italian Society of Colo-Rectal Surgery reports on the treatment of chronic constipation and obstructed defecation.There is no evidence that increasing fluid intake and physical activity can relieve the symptoms of chronic constipation.Patients with normal-transit constipation should increase their fibre intake through their diet or with commercial fibre.Osmotic laxatives may be effective in patients who do not respond to fibre supplements.Stimulant laxatives should be reserved for patients who do not respond to osmotic laxatives.Controlled trials have shown that serotoninergic enterokinetic agents,such as prucalopride,and prosecretory agents,such as lubiprostone,are effective in the treatment of patients with chronic constipation.Surgery is sometimes necessary.Total colectomy with ileorectostomy may be considered in patients with slow-transit constipation and inertia coli who are resistant to medical therapy and who do not have defecatory disorders,generalised motility disorders or psychological disorders.Randomised controlled trials have established the efficacy of rehabilitative treatment in dys-synergic defecation.Many surgical procedures may be used to treat obstructed defecation in patients with acquired anatomical defects,but none is considered to be the gold standard.Surgery should be reserved for selected patients with an impaired quality of life.Obstructed defecation is often associated with pelvic organ prolapse.Surgery with the placement of prostheses is replacing fascial surgery in the treatment of pelvic organ prolapse,but the efficacy and safety of such procedures have not yet been established.展开更多
目的 比较吻合器痔上黏膜环切术(PPH)与经肛吻合器直肠切除术(STARR)治疗重度脱垂痔的临床疗效。方法 选择2015年1月至2016年3月北京市隆福医院收治的重度脱垂痔患者70例,根据治疗方法不同分为PPH组和STARR组,每组35例。PPH组行PPH手术,...目的 比较吻合器痔上黏膜环切术(PPH)与经肛吻合器直肠切除术(STARR)治疗重度脱垂痔的临床疗效。方法 选择2015年1月至2016年3月北京市隆福医院收治的重度脱垂痔患者70例,根据治疗方法不同分为PPH组和STARR组,每组35例。PPH组行PPH手术,STARR组行STARR手术。观察两组患者的临床疗效、临床各项指标、术后疼痛及术后并发症等。结果 术后12个月,STARR组总有效率高于PPH组[97.14%(34/35)比74.29%(26/35)]( P <0.05)。两组患者手术时间、住院时间、恢复胃肠功能时间、术中出血量、进食时间比较差异均无统计学意义( P >0.05),STARR组住院费用高于PPH组( P <0.01)。术后1个月、6个月、12个月,两组视觉模拟评分(VAS)均呈下降趋势,且STARR组各时点VAS评分均低于PPH组( P <0.05),两组间、时点间、组间和时点间交互作用比较差异均有统计学意义( P <0.05)。STARR组总并发症发生率低于PPH组[2.86%(1/35)比 28.57 %(10/35)]( P <0.05)。结论 与PHH手术相比,STARR手术治疗重度脱垂痔效果显著,能有效缓解患者疼痛症状且术后并发症发生率低。展开更多
目的：探讨痔上黏膜环切术（Procedure for Prolapse and Hemorrhoids，PPH）及经肛吻合器直肠切除术（Stapled Trans-anal Rectal Resection，STARR）治疗出口梗阻型便秘的临床疗效。方法：选择2012年5月-2014年5月在我院接受治疗的梗...目的：探讨痔上黏膜环切术（Procedure for Prolapse and Hemorrhoids，PPH）及经肛吻合器直肠切除术（Stapled Trans-anal Rectal Resection，STARR）治疗出口梗阻型便秘的临床疗效。方法：选择2012年5月-2014年5月在我院接受治疗的梗阻型便秘患者100例，随机分为PPH组和STARR组，每组各50例，分别予PPH术和STARR术治疗。观察并比较两组患者治疗前后Longo出口梗阻型便秘评分及Wexner便秘严重程度评分。结果：两组患者术中出血量比较，差异无统计学意义（P〉0．05）：PPH组患者手术时间、住院时间及治疗费用明显少于STARR组，差异有统计学意义（P〈0．05）。两组患者术后并发痘的发生率无显著差异，无统计学意义（P〉0．05）。两组患者术前Longo评分及Wexner评分比较，差异无统计学意义（P〉0．05）；术后STARR组评分低于PPH组，差异有统计学意义（P〈0．05）。结论：与经肛吻合器直肠切除术相比，痔上黏膜环切术操作简单，更易被患者接受，值得临床推广应用。展开更多
文摘AIM:To prospectively assess the eff icacy and safety of stapled trans-anal rectal resection(STARR) compared to standard conservative treatment,and whether preoperative symptoms and findings at defecography and anorectal manometry can predict the outcome of STARR.METHODS:Thirty patients(Female,28;age:51 ± 9 years) with rectocele or rectal intussusception,a defecation disorder,and functional constipation were submitted for STARR.Thirty comparable patients(Female,30;age 53 ± 13 years),who presented with symptoms of rectocele or rectal intussusception and were treated with macrogol,were assessed.Patients were interviewed with a standardized questionnaire at study enrollment and 38 ± 18 mo after the STARR procedure or during macrogol treatment.A responder was def ined as an absence of the Rome Ⅲ diagnostic criteria for functional constipation.Defecography and rectoanal manometry were performed before and after the STARR procedure in 16 and 12 patients,respectively.RESULTS:After STARR,53% of patients were responders;during conservative treatment,75% were responders.After STARR,30% of the patients reported the use of laxatives,17% had intermittent anal pain,13% had anal leakage,13% required digital facilitation,6% experienced defecatory urgency,6% experienced fecal incontinence,and 6% required re-intervention.During macrogol therapy,23% of the patients complained of abdominal bloating and 13% of borborygmi,and 3% required digital facilitation.No preoperative symptom,defecographic,or manometric finding predicted the outcome of STARR.Post-operative defecography showed a statistically significant reduction(P < 0.05) of the rectal diameter and rectocele.The postoperative anorectal manometry showed that anal pressure and rectal sensitivity were not significantly modified,and that rectal compliance was reduced(P = 0.01).CONCLUSION:STARR is not better and is less safe than macrogol in the treatment of defecation disorders.It could be considered as an alternative therapy in patients unresponsive to macrogol.
基金Supported by Associazione Italiana Gastroenterologi and Endoscopisti Digestivi Ospedalieri, Via N Colajanni, 4, 00191 Roma, ItalySocietà Italiana di Chirurgia Colo-Rettale, Via Medici, 23, 10143 Torino, Italy
文摘The second part of the Consensus Statement of the Italian Association of Hospital Gastroenterologists and Italian Society of Colo-Rectal Surgery reports on the treatment of chronic constipation and obstructed defecation.There is no evidence that increasing fluid intake and physical activity can relieve the symptoms of chronic constipation.Patients with normal-transit constipation should increase their fibre intake through their diet or with commercial fibre.Osmotic laxatives may be effective in patients who do not respond to fibre supplements.Stimulant laxatives should be reserved for patients who do not respond to osmotic laxatives.Controlled trials have shown that serotoninergic enterokinetic agents,such as prucalopride,and prosecretory agents,such as lubiprostone,are effective in the treatment of patients with chronic constipation.Surgery is sometimes necessary.Total colectomy with ileorectostomy may be considered in patients with slow-transit constipation and inertia coli who are resistant to medical therapy and who do not have defecatory disorders,generalised motility disorders or psychological disorders.Randomised controlled trials have established the efficacy of rehabilitative treatment in dys-synergic defecation.Many surgical procedures may be used to treat obstructed defecation in patients with acquired anatomical defects,but none is considered to be the gold standard.Surgery should be reserved for selected patients with an impaired quality of life.Obstructed defecation is often associated with pelvic organ prolapse.Surgery with the placement of prostheses is replacing fascial surgery in the treatment of pelvic organ prolapse,but the efficacy and safety of such procedures have not yet been established.
文摘目的 比较吻合器痔上黏膜环切术(PPH)与经肛吻合器直肠切除术(STARR)治疗重度脱垂痔的临床疗效。方法 选择2015年1月至2016年3月北京市隆福医院收治的重度脱垂痔患者70例,根据治疗方法不同分为PPH组和STARR组,每组35例。PPH组行PPH手术,STARR组行STARR手术。观察两组患者的临床疗效、临床各项指标、术后疼痛及术后并发症等。结果 术后12个月,STARR组总有效率高于PPH组[97.14%(34/35)比74.29%(26/35)]( P <0.05)。两组患者手术时间、住院时间、恢复胃肠功能时间、术中出血量、进食时间比较差异均无统计学意义( P >0.05),STARR组住院费用高于PPH组( P <0.01)。术后1个月、6个月、12个月,两组视觉模拟评分(VAS)均呈下降趋势,且STARR组各时点VAS评分均低于PPH组( P <0.05),两组间、时点间、组间和时点间交互作用比较差异均有统计学意义( P <0.05)。STARR组总并发症发生率低于PPH组[2.86%(1/35)比 28.57 %(10/35)]( P <0.05)。结论 与PHH手术相比,STARR手术治疗重度脱垂痔效果显著,能有效缓解患者疼痛症状且术后并发症发生率低。
文摘目的：探讨痔上黏膜环切术（Procedure for Prolapse and Hemorrhoids，PPH）及经肛吻合器直肠切除术（Stapled Trans-anal Rectal Resection，STARR）治疗出口梗阻型便秘的临床疗效。方法：选择2012年5月-2014年5月在我院接受治疗的梗阻型便秘患者100例，随机分为PPH组和STARR组，每组各50例，分别予PPH术和STARR术治疗。观察并比较两组患者治疗前后Longo出口梗阻型便秘评分及Wexner便秘严重程度评分。结果：两组患者术中出血量比较，差异无统计学意义（P〉0．05）：PPH组患者手术时间、住院时间及治疗费用明显少于STARR组，差异有统计学意义（P〈0．05）。两组患者术后并发痘的发生率无显著差异，无统计学意义（P〉0．05）。两组患者术前Longo评分及Wexner评分比较，差异无统计学意义（P〉0．05）；术后STARR组评分低于PPH组，差异有统计学意义（P〈0．05）。结论：与经肛吻合器直肠切除术相比，痔上黏膜环切术操作简单，更易被患者接受，值得临床推广应用。
