Stapled transanal rectal resection for obstructed defecation syndrome associated with rectocele and rectal intussusception

AIM:To evaluate the safety and efficacy of stapled transanal rectal resection(STARR),and to analyze the outcome of the patients 12-mo after the operation.METHODS:From May 2007 to October 2008,50 female patients with rectocele and/or rectal intussusception underwent STARR.The preoperative status,perioperative and postoperative complications at baseline,3,6 and 12-mo were assessed.Data were collected prospectively from standardized questionnaires for the assessment of constipation[constipation scoring system,Longo’s obstructed defecation syndrome(ODS)score system,symptom severity score],patient satisfaction (visual analogue scale),and quality of life(Patient Assessment of Constipation-Quality of Life Questionnaire).RESULTS:At a 12-mo follow-up,significant improvement in the constipation scoring system,ODS score system,symptom severity score,visual analog scale and quality of life(P<0.0001)was observed.The symptoms of constipation improved in 90%of patients at 12 mo after surgery.The self-reported definitive outcome was excellent in 15(30%)patients,fairly good in 8(16%),good in 22(44%),and poor in 5(10%).CONCLUSION:STARR can be performed safely without major morbidity.Moreover,the procedure seems to be effective for patients with obstructed defecation associated with symptomatic rectocele and rectal intussusception.

改良Bresler手术对直肠前突合并直肠套叠的治疗效果

背景:梗阻性排便综合征(ODS)是一种多由直肠前突和直肠套叠引起的排便障碍。本研究旨在通过与吻合器经肛直肠切除术(STARR)的比较,评估一种改良Bresler手术治疗ODS的疗效。方法:回顾性分析2014年6月至2016年6月间76例女性ODS患者的临床资料。按手术方式分为改良组和STARR组。改良组36例患者行改良Bresler手术,采用圆形管状吻合器加多层荷包缝合进行直肠后壁切除。STARR组40例患者则进行标准的STARR手术。记录术后并发症、Wexner便秘评分(WCS)、直肠前突深度和四分法术后满意度量表。结果:改良组手术时间更短,术后并发症更少(均P<0.05)。术后12个月,两组患者WCS评分和前突深度均得以改善;组间比较,改良组WCS评分显著低于STARR组(P<0.05),但前突深度两组差异无统计学意义(P>0.05)。术后12个月随访,改良组患者有更高的满意度(P=0.05)。结论:对于由直肠前突和直肠套叠引起的ODS,我们的改良Bresler术式是一种有效的治疗方式,可有效缓解便秘症状,且并发症更少。