BACKGROUND Obstructed defecation syndrome(ODS)represents the most prevalent form of chronic constipation,affecting a diverse patient population,leading to numerous complications,and imposing a significant burden on he...BACKGROUND Obstructed defecation syndrome(ODS)represents the most prevalent form of chronic constipation,affecting a diverse patient population,leading to numerous complications,and imposing a significant burden on healthcare resources.Most ODS patients have insufficient rectal propulsion,but the exact mechanism underlying the pathogenesis of ODS remains unclear.AIM To explore the molecular mechanism underlying the pathogenesis of ODS.METHODS A total of 30 pairs of rectal samples were collected from patients with ODS(ODS group)or grade IV prolapsed hemorrhoids without constipation(control group)for quantitative proteomic and bioinformatic analysis.Subsequently,50 pairs of paraffin-embedded rectal specimens were selected for immunohistochemistry and immunofluorescence studies to validate the analysis results.Human intestinal smooth cell contractile function experiments and electrophysiological experiments were conducted to verify the physiological functions of target proteins.Cellular ultrastructure was detected using transmission electron microscopy.RESULTS In comparison to the control group,the expression level of dystrophin(DMD)in rectal specimens from ODS patients was markedly reduced.This finding was corroborated using immunohistochemistry and immunofluorescence techniques.The diminished expression of DMD compromised the contractile function of intestinal smooth muscle cells.At the molecular level,nucleoporin protein 153 and L-type voltage-gated calcium channel were found to be overexpressed in intestinal smooth muscle cells exhibiting downregulated DMD expression.Electrophysiological experiments confirmed an excessive influx of calcium ions into these cells.Moreover,vacuolar-like structures which may be associated with excessive calcium influx were observed in the cells by transmission electron microscopy.CONCLUSION Decreased DMD expression in intestinal smooth muscle may upregulate L-type voltage-gated calcium channel expression,leading to excessive calcium influx which may cause a decrease in rectal propulsion,thereby contributing to the pathogenesis of ODS.展开更多
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 r...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.展开更多
Obstructive defecation syndrome(ODS) is a common disorder with a considerable impact on the quality of life of affected patients.Surgery for ODS remains a challenging topic.There exists a great variety of operative te...Obstructive defecation syndrome(ODS) is a common disorder with a considerable impact on the quality of life of affected patients.Surgery for ODS remains a challenging topic.There exists a great variety of operative techniques to treat patients with ODS.According to the surgeon's preference the approach can be transanal,transvaginal,transperineal or transabdominal.All techniques have its advantages and disadvantages.Notably,high evidence based studies are significantly lacking in literature,thus making accurate assessments difficult.Careful patient's selection is crucial to achieveoptimal functional results.It is mandatory to assess not only defecation disorders but also evaluate overall pelvic floor symptoms,such as fecal incontinence and urinary disorders for choosing an appropriate and tailored strategy.Radiological investigation is essential but may not explain complaints of every patient.展开更多
Obstructed defecation syndrome(ODS) is a functional disorder commonly encountered by colorectal surgeons and gastroenterologists, and greatly affects the quality of life of patients from both societal and psychologica...Obstructed defecation syndrome(ODS) is a functional disorder commonly encountered by colorectal surgeons and gastroenterologists, and greatly affects the quality of life of patients from both societal and psychological aspects. The underlying anatomical and pathophysiological changes of ODS are complex. However, intra-rectal intussusception and rectocele are frequently found in patients with ODS and both are thought to play an important role in the pathogenesis of ODS. With the development of evaluation methods in anorectal physiology laboratories and radiology studies, a great variety of new operative procedures, especially transanal procedures, have been invented to treat ODS. However, no procedure has been proved to be superior to others at present. Each operation has its own merits and defects. Thus, choosing appropriate transanal surgical procedures for the treatment of ODS remains a challenge for all surgeons. This review provides an introduction of the current problems and options for treatment of ODS and a detailed summary of the essential assessments needed for patient evaluation before carrying out transanal surgery. Besides, an overview of the benefits and problems of current transanal surgical procedures for treatment of ODS is summarized in this review. A report of clinical experience of some transanal surgical techniques used in the authors' center is also presented.展开更多
BACKGROUND Abdominal ventral rectopexy(AVR)with colectomy is controversial in the treatment of obstructed defecation syndrome(ODS).Literature data on this technique for ODS are very limited.AIM To evaluate the safety ...BACKGROUND Abdominal ventral rectopexy(AVR)with colectomy is controversial in the treatment of obstructed defecation syndrome(ODS).Literature data on this technique for ODS are very limited.AIM To evaluate the safety and efficacy of AVR with colectomy for selected patients with ODS.METHODS Consecutive patients who underwent AVR with colectomy for ODS were identified prospectively from 2016 to 2017 in our department.Patient demographics,perioperative surgical results,and postoperative follow-up outcomes were collected and analyzed.Long-term follow-up was evaluated with standardized questionnaires.The severity of symptoms was assessed by the objective Wexner Constipation Score(WCS)and ODS Score.The quality of life was assessed by the Patients Assessment of Constipation Quality of Life score.Functional outcome was compared pre-and post-operatively for each patient.The primary outcomes were determined by the improvement in symptoms and quality of life.Secondary outcome measures were operating time,postoperative length of stay,morbidity and mortality,improvement of pelvic floor structure,and patient satisfaction.RESULTS Four patients underwent robotic-assisted surgery,and two patients underwent a laparoscopic-assisted procedure.The mean operating time for the robotic approach was 243 min(range 160–300 min),and the mean operating time for the laparoscopic approach was 230 min(range 220-240 min).The mean postoperative length of stay was 8.2 d(range 6-12 d).There was no conversion to open procedure and no postoperative mortality.No urinary retention,wound infection,prolonged ileus,pelvic infection and anastomosis leakage occurred.Six patients were followed up for 36 mo.The WCS,ODS,and Patients Assessment of Constipation Quality of Life score improved significantly postoperatively(P<0.05).The WCS and ODS scores showed the best remission and stabilization at 6 to 12 mo after surgery.There was no recurrence or novel constipation after surgery.None of the patients used laxative medication.CONCLUSION Robotic and laparoscopic-assisted ventral rectopexy with colectomy is a safe and effective procedure for selected patients with ODS.However,comprehensive preoperative evaluation and careful patient selection are essential.展开更多
Background:Obstructed defecation syndrome(ODS)is a group of symptoms that are mainly caused by pelvic floor dysfunction concerning bowel symptoms.It is challenging in clinical practice.Acupuncture has advantages in th...Background:Obstructed defecation syndrome(ODS)is a group of symptoms that are mainly caused by pelvic floor dysfunction concerning bowel symptoms.It is challenging in clinical practice.Acupuncture has advantages in the treatment of complex symptoms because of its multi-target and bi-directional regulation of the human body.Since 2500 years ago,acupuncture has been applied empirically to the treatment of constipation.Does acupuncture have any effect on ODS?Objectives:By showing the clinical thoughts,methods,and achievements of acupuncture series in ODS in recent ten years by the author’s team,and two scientific papers published in English on acupuncture treatment of chronic intractable constipation and stress urinary incontinence,it is proved that the core scheme of acupuncture treatment of defecation disorder syndrome(ODS)is flexible.In order to raise awareness of the therapeutic effect of acupuncture in ODS,it can be integrated into existing practice to get opportunities for multidisciplinary cooperation and further research and development.Materials and Methods:By summarizing the diagnosis and treatment of ODS,the first-line selection of pelvic floor rehabilitation and the minimally invasive sacral neuromodulation were reviewed,and it was pointed out that there was a gap between the high demand of patients and the expectation of cost-effectiveness.Then,on the basis of modern eastern and western medical achievements,the holistic concept was introduced into the treatment of pelvic floor dysfunction,and an acupuncture scheme suitable for ODS was proposed.Results:Acupuncture is based on the idea of improving the patients’central nervous system,autonomic nervous system and intestinal nervous system,and is effective in treating ODS.The acupoints were set two groups when patient in supine position,which includes ST 25(Tianshu),SP 15(Daheng),SP 14(Fujie),CV 6(Qihai),CV 4(Guanyuan),ST 36(Zusanli),ST 37(Shangjuxu);When patient is in prone position,it includes BL 20(Pishu),BL 23(Shenshu),BL 25(Dachangshu),BL 33(Zhongliao),BL 34(Xialiao),and GV 20(Baihui).The key was the technique of deep needling of the ST 25(Tianshu)and deep needling of the BL 33(Zhongliao)&BL 34(Xialiao).It needs 2-15 Hz sparse-dense wave electrical stimulation,30 minutes each time,a total of 20 times,which was a scheme that could achieve satisfactory short-term and long-term effects.Conclusion:At present,clinical and basic experimental studies have proved that acupuncture plays a role in treating ODS in a multi-target way.This is a very promising research direction of pelvic floor integrated medicine.In the future,further study on optimizing the protocol and meeting the patient’s gap individually and cost-effectively.展开更多
Background: Stapled transanal rectal resection (STARR) has been shown to improve patients’ functional and quality of life outcomes in several studies. Although it is a safe and effective treatment for obstructive def...Background: Stapled transanal rectal resection (STARR) has been shown to improve patients’ functional and quality of life outcomes in several studies. Although it is a safe and effective treatment for obstructive defecation syndrome, still data on long-term follow-up are missing. Methods: From January 2010 to July 2014, 46 consecutive patients undergoing STARR using the CONTOUR® TRANSTAR™ device, shortly named TRANSTAR (transanal stapler assisted resection), were prospectively followed. Recurrence rate, quality of life (Patient Assessment of Constipation-Quality of Life (PAC-Qol)) and complication were documented at baseline, 12 and 24 months after operation. Two subgroups of patients were compared to assess the impact of resection length on outcome. Results: We included 46 patients (89% female) in the study. The mean age was 65 ± 16 years and the duration of the operation was 48 ± 4 min. Total PAC-QoL score improved from 2.0 (SD 0.3) to 0.9 (1.4) after 12 months, but deteriorated to 1.2 (0.3) after 24 months (p < 0.001 for both comparisons). Complications were noted in 7% of the patients: Urinary retention (2 patients), postoperative bleeding (1 patient). No major complications or mortality were seen. After one year, we had one prolapse recurrence and after 24 month we had another. There was no significant relation between the length of the specimen and the improvement of life quality. Conclusions: The STARR procedure seems to be a safe and fast therapeutic option for patients with ODS and/or rectal prolapse. It is a tailored transanal full-thickness rectal resection improving the patients’ quality of life still two years after the operation.展开更多
Objective:The present study was designed to evaluate the functional outcome of stapled transanal rectal resection(STARR)and to examine the relationship between the population density of the interstitial cells of Cajal...Objective:The present study was designed to evaluate the functional outcome of stapled transanal rectal resection(STARR)and to examine the relationship between the population density of the interstitial cells of Cajal(ICC)and the efficacy of the STARR operation in the management of obstructed defecation syndrome(ODS)patients.Methods:Full-thickness rectal samples were obtained from 50 ODS patients who underwent STARR.Samples were analysed using ICC immunohistochemistry.Clinical and functional parameters obtained with defecography and anorectal manometry were compared with 20 controls.Results:ICCs were significantly decreased in patients in the submucosal(SM),intramuscular(IM)andmyenteric(MY)regions when compared with the control group(P<0.05).The mean pre-operative Cleveland Constipation Score(CCS)was 24.264.1,whilst the CCS at 1,2,3,4 and 5 years post-operatively decreased significantly(P<0.05).At 3 post-operative years,58.3%(28/48)of the patients reported a favorable outcome(CCS10).On univariate analysis,the functional results were worse in those with pre-operative digitation(P=0.017),a decreased ICC-MY cell population(P=0.067),a higher resting anal canal pressure(P=0.039)and a higher rectal sensory threshold(P=0.073).Multivariate analysis showed the decreased ICC-MY cell population was an independent predictor for low unfavorable functional outcome(odds ratio=0.097,95%confidence interval:0.012–0.766).Conclusions:STARR achieved acceptable results at the cost of a slight deterioration over amore prolonged follow-up.Patients with a decreased ICC number in the rectal specimen showed an unfavorable functional outcome where pre-operative histological assessment of a full-thickness rectal samplemight predict for the functional outcome following STARR.展开更多
BACKGROUND Obstructed defecation syndrome(ODS) is a widespread disease in the world.Rectocele is the most common cause of ODS in females. Multiple procedures have been performed to treat rectocele and no procedure has...BACKGROUND Obstructed defecation syndrome(ODS) is a widespread disease in the world.Rectocele is the most common cause of ODS in females. Multiple procedures have been performed to treat rectocele and no procedure has been accepted as the gold-standard procedure. Stapled transanal rectal resection(STARR) has been widely used. However, there are still some disadvantages in this procedure and its effectiveness in anterior wall repair is doubtful. Therefore, new procedures are expected to further improve the treatment of rectocele.AIM To evaluate the efficacy and safety of a novel rectocele repair combining Khubchandani's procedure with stapled posterior rectal wall resection.METHODS A cohort of 93 patients were recruited in our randomized clinical trial and were divided into two different groups in a randomized manner. Forty-two patients(group A) underwent Khubchandani's procedure with stapled posterior rectal wall resection and 51 patients(group B) underwent the STARR procedure.Follow-up was performed at 1, 3, 6, and 12 mo after the operation. Preoperative and postoperative ODS scores and depth of rectocele, postoperative complications, blood loss, and hospital stay of each patient were documented. All data were analyzed statistically to evaluate the efficiency and safety of our procedure.RESULTS In group A, 42 patients underwent Khubchandani's procedure with stapled posterior rectal wall resection and 34 were followed until the final analysis. In group B, 51 patients underwent the STARR procedure and 37 were followed until the final analysis. Mean operative duration was 41.47 ± 6.43 min(group A) vs39.24 ± 6.53 min(group B). Mean hospital stay was 3.15 ± 0.70 d(group A) vs 3.14± 0.54 d(group B). Mean blood loss was 10.91 ± 2.52 mL(group A) vs 10.14 ± 1.86 m L(group B). Mean ODS score in group A declined from 16.50 ± 2.06 before operation to 5.06 ± 1.07 one year after the operation, whereas in group B it was17.11 ± 2.57 before operation and 6.03 ± 2.63 one year after the operation. Mean depth of rectocele decreased from 4.32 ± 0.96 cm(group A) vs 4.18 ± 0.95 cm(group B) preoperatively to 1.19 ± 0.43 cm(group A) vs 1.54 ± 0.82 cm(group B)one year after operation. No other serious complications, such as rectovaginal fistula, perianal sepsis, or deaths, were recorded. After 12 mo of follow-up, 30 patients'(30/34, 88.2%) final outcomes were judged as effective and 4(4/34,11.8%) as moderate in group A, whereas in group B, 30(30/37, 81.1%) patients' outcomes were judged as effective, 5(5/37, 13.5%) as moderate, and 2(2/37,5.4%) as poor.CONCLUSION Khubchandani's procedure combined with stapled posterior rectal wall resection is an effective, feasible, and safe procedure with minor trauma to rectocele.展开更多
基金Supported by the National Natural Science Foundation of China,No.81500505the Construction of Predominant Disciplines of Zhongnan Hospital of Wuhan University,No.XKJS202017+1 种基金the Medical Science and Technology Innovation Platform of Joint Foundation of Health Commission of Hubei Province,Zhongnan Hospital of Wuhan University,No.PTXM2021025the Hubei Provincial Natural Science Foundation,No.2023AFC013.
文摘BACKGROUND Obstructed defecation syndrome(ODS)represents the most prevalent form of chronic constipation,affecting a diverse patient population,leading to numerous complications,and imposing a significant burden on healthcare resources.Most ODS patients have insufficient rectal propulsion,but the exact mechanism underlying the pathogenesis of ODS remains unclear.AIM To explore the molecular mechanism underlying the pathogenesis of ODS.METHODS A total of 30 pairs of rectal samples were collected from patients with ODS(ODS group)or grade IV prolapsed hemorrhoids without constipation(control group)for quantitative proteomic and bioinformatic analysis.Subsequently,50 pairs of paraffin-embedded rectal specimens were selected for immunohistochemistry and immunofluorescence studies to validate the analysis results.Human intestinal smooth cell contractile function experiments and electrophysiological experiments were conducted to verify the physiological functions of target proteins.Cellular ultrastructure was detected using transmission electron microscopy.RESULTS In comparison to the control group,the expression level of dystrophin(DMD)in rectal specimens from ODS patients was markedly reduced.This finding was corroborated using immunohistochemistry and immunofluorescence techniques.The diminished expression of DMD compromised the contractile function of intestinal smooth muscle cells.At the molecular level,nucleoporin protein 153 and L-type voltage-gated calcium channel were found to be overexpressed in intestinal smooth muscle cells exhibiting downregulated DMD expression.Electrophysiological experiments confirmed an excessive influx of calcium ions into these cells.Moreover,vacuolar-like structures which may be associated with excessive calcium influx were observed in the cells by transmission electron microscopy.CONCLUSION Decreased DMD expression in intestinal smooth muscle may upregulate L-type voltage-gated calcium channel expression,leading to excessive calcium influx which may cause a decrease in rectal propulsion,thereby contributing to the pathogenesis of ODS.
文摘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.
文摘Obstructive defecation syndrome(ODS) is a common disorder with a considerable impact on the quality of life of affected patients.Surgery for ODS remains a challenging topic.There exists a great variety of operative techniques to treat patients with ODS.According to the surgeon's preference the approach can be transanal,transvaginal,transperineal or transabdominal.All techniques have its advantages and disadvantages.Notably,high evidence based studies are significantly lacking in literature,thus making accurate assessments difficult.Careful patient's selection is crucial to achieveoptimal functional results.It is mandatory to assess not only defecation disorders but also evaluate overall pelvic floor symptoms,such as fecal incontinence and urinary disorders for choosing an appropriate and tailored strategy.Radiological investigation is essential but may not explain complaints of every patient.
基金Supported by National Natural Science Foundation of China,No.81500505 and No.81570492Natural Science Foundation of Hubei Province of China,No.2015CFB636
文摘Obstructed defecation syndrome(ODS) is a functional disorder commonly encountered by colorectal surgeons and gastroenterologists, and greatly affects the quality of life of patients from both societal and psychological aspects. The underlying anatomical and pathophysiological changes of ODS are complex. However, intra-rectal intussusception and rectocele are frequently found in patients with ODS and both are thought to play an important role in the pathogenesis of ODS. With the development of evaluation methods in anorectal physiology laboratories and radiology studies, a great variety of new operative procedures, especially transanal procedures, have been invented to treat ODS. However, no procedure has been proved to be superior to others at present. Each operation has its own merits and defects. Thus, choosing appropriate transanal surgical procedures for the treatment of ODS remains a challenge for all surgeons. This review provides an introduction of the current problems and options for treatment of ODS and a detailed summary of the essential assessments needed for patient evaluation before carrying out transanal surgery. Besides, an overview of the benefits and problems of current transanal surgical procedures for treatment of ODS is summarized in this review. A report of clinical experience of some transanal surgical techniques used in the authors' center is also presented.
基金Supported by National Natural Science Foundation of China,No.81570483 and 81770541Technology Innovation Project of Chongqing,No.cstc2019jscxmsxmX0227 and cstc2015shmszx120109.
文摘BACKGROUND Abdominal ventral rectopexy(AVR)with colectomy is controversial in the treatment of obstructed defecation syndrome(ODS).Literature data on this technique for ODS are very limited.AIM To evaluate the safety and efficacy of AVR with colectomy for selected patients with ODS.METHODS Consecutive patients who underwent AVR with colectomy for ODS were identified prospectively from 2016 to 2017 in our department.Patient demographics,perioperative surgical results,and postoperative follow-up outcomes were collected and analyzed.Long-term follow-up was evaluated with standardized questionnaires.The severity of symptoms was assessed by the objective Wexner Constipation Score(WCS)and ODS Score.The quality of life was assessed by the Patients Assessment of Constipation Quality of Life score.Functional outcome was compared pre-and post-operatively for each patient.The primary outcomes were determined by the improvement in symptoms and quality of life.Secondary outcome measures were operating time,postoperative length of stay,morbidity and mortality,improvement of pelvic floor structure,and patient satisfaction.RESULTS Four patients underwent robotic-assisted surgery,and two patients underwent a laparoscopic-assisted procedure.The mean operating time for the robotic approach was 243 min(range 160–300 min),and the mean operating time for the laparoscopic approach was 230 min(range 220-240 min).The mean postoperative length of stay was 8.2 d(range 6-12 d).There was no conversion to open procedure and no postoperative mortality.No urinary retention,wound infection,prolonged ileus,pelvic infection and anastomosis leakage occurred.Six patients were followed up for 36 mo.The WCS,ODS,and Patients Assessment of Constipation Quality of Life score improved significantly postoperatively(P<0.05).The WCS and ODS scores showed the best remission and stabilization at 6 to 12 mo after surgery.There was no recurrence or novel constipation after surgery.None of the patients used laxative medication.CONCLUSION Robotic and laparoscopic-assisted ventral rectopexy with colectomy is a safe and effective procedure for selected patients with ODS.However,comprehensive preoperative evaluation and careful patient selection are essential.
文摘Background:Obstructed defecation syndrome(ODS)is a group of symptoms that are mainly caused by pelvic floor dysfunction concerning bowel symptoms.It is challenging in clinical practice.Acupuncture has advantages in the treatment of complex symptoms because of its multi-target and bi-directional regulation of the human body.Since 2500 years ago,acupuncture has been applied empirically to the treatment of constipation.Does acupuncture have any effect on ODS?Objectives:By showing the clinical thoughts,methods,and achievements of acupuncture series in ODS in recent ten years by the author’s team,and two scientific papers published in English on acupuncture treatment of chronic intractable constipation and stress urinary incontinence,it is proved that the core scheme of acupuncture treatment of defecation disorder syndrome(ODS)is flexible.In order to raise awareness of the therapeutic effect of acupuncture in ODS,it can be integrated into existing practice to get opportunities for multidisciplinary cooperation and further research and development.Materials and Methods:By summarizing the diagnosis and treatment of ODS,the first-line selection of pelvic floor rehabilitation and the minimally invasive sacral neuromodulation were reviewed,and it was pointed out that there was a gap between the high demand of patients and the expectation of cost-effectiveness.Then,on the basis of modern eastern and western medical achievements,the holistic concept was introduced into the treatment of pelvic floor dysfunction,and an acupuncture scheme suitable for ODS was proposed.Results:Acupuncture is based on the idea of improving the patients’central nervous system,autonomic nervous system and intestinal nervous system,and is effective in treating ODS.The acupoints were set two groups when patient in supine position,which includes ST 25(Tianshu),SP 15(Daheng),SP 14(Fujie),CV 6(Qihai),CV 4(Guanyuan),ST 36(Zusanli),ST 37(Shangjuxu);When patient is in prone position,it includes BL 20(Pishu),BL 23(Shenshu),BL 25(Dachangshu),BL 33(Zhongliao),BL 34(Xialiao),and GV 20(Baihui).The key was the technique of deep needling of the ST 25(Tianshu)and deep needling of the BL 33(Zhongliao)&BL 34(Xialiao).It needs 2-15 Hz sparse-dense wave electrical stimulation,30 minutes each time,a total of 20 times,which was a scheme that could achieve satisfactory short-term and long-term effects.Conclusion:At present,clinical and basic experimental studies have proved that acupuncture plays a role in treating ODS in a multi-target way.This is a very promising research direction of pelvic floor integrated medicine.In the future,further study on optimizing the protocol and meeting the patient’s gap individually and cost-effectively.
文摘Background: Stapled transanal rectal resection (STARR) has been shown to improve patients’ functional and quality of life outcomes in several studies. Although it is a safe and effective treatment for obstructive defecation syndrome, still data on long-term follow-up are missing. Methods: From January 2010 to July 2014, 46 consecutive patients undergoing STARR using the CONTOUR® TRANSTAR™ device, shortly named TRANSTAR (transanal stapler assisted resection), were prospectively followed. Recurrence rate, quality of life (Patient Assessment of Constipation-Quality of Life (PAC-Qol)) and complication were documented at baseline, 12 and 24 months after operation. Two subgroups of patients were compared to assess the impact of resection length on outcome. Results: We included 46 patients (89% female) in the study. The mean age was 65 ± 16 years and the duration of the operation was 48 ± 4 min. Total PAC-QoL score improved from 2.0 (SD 0.3) to 0.9 (1.4) after 12 months, but deteriorated to 1.2 (0.3) after 24 months (p < 0.001 for both comparisons). Complications were noted in 7% of the patients: Urinary retention (2 patients), postoperative bleeding (1 patient). No major complications or mortality were seen. After one year, we had one prolapse recurrence and after 24 month we had another. There was no significant relation between the length of the specimen and the improvement of life quality. Conclusions: The STARR procedure seems to be a safe and fast therapeutic option for patients with ODS and/or rectal prolapse. It is a tailored transanal full-thickness rectal resection improving the patients’ quality of life still two years after the operation.
基金supported by the National Natural Science Foundation of China(No.81603628),Medical Scientific Research Foundation of Guangdong Province,China(No.A2015180)and Sun Yat-Sen University Clinical Research 5010 Program(No.2017017).
文摘Objective:The present study was designed to evaluate the functional outcome of stapled transanal rectal resection(STARR)and to examine the relationship between the population density of the interstitial cells of Cajal(ICC)and the efficacy of the STARR operation in the management of obstructed defecation syndrome(ODS)patients.Methods:Full-thickness rectal samples were obtained from 50 ODS patients who underwent STARR.Samples were analysed using ICC immunohistochemistry.Clinical and functional parameters obtained with defecography and anorectal manometry were compared with 20 controls.Results:ICCs were significantly decreased in patients in the submucosal(SM),intramuscular(IM)andmyenteric(MY)regions when compared with the control group(P<0.05).The mean pre-operative Cleveland Constipation Score(CCS)was 24.264.1,whilst the CCS at 1,2,3,4 and 5 years post-operatively decreased significantly(P<0.05).At 3 post-operative years,58.3%(28/48)of the patients reported a favorable outcome(CCS10).On univariate analysis,the functional results were worse in those with pre-operative digitation(P=0.017),a decreased ICC-MY cell population(P=0.067),a higher resting anal canal pressure(P=0.039)and a higher rectal sensory threshold(P=0.073).Multivariate analysis showed the decreased ICC-MY cell population was an independent predictor for low unfavorable functional outcome(odds ratio=0.097,95%confidence interval:0.012–0.766).Conclusions:STARR achieved acceptable results at the cost of a slight deterioration over amore prolonged follow-up.Patients with a decreased ICC number in the rectal specimen showed an unfavorable functional outcome where pre-operative histological assessment of a full-thickness rectal samplemight predict for the functional outcome following STARR.
文摘BACKGROUND Obstructed defecation syndrome(ODS) is a widespread disease in the world.Rectocele is the most common cause of ODS in females. Multiple procedures have been performed to treat rectocele and no procedure has been accepted as the gold-standard procedure. Stapled transanal rectal resection(STARR) has been widely used. However, there are still some disadvantages in this procedure and its effectiveness in anterior wall repair is doubtful. Therefore, new procedures are expected to further improve the treatment of rectocele.AIM To evaluate the efficacy and safety of a novel rectocele repair combining Khubchandani's procedure with stapled posterior rectal wall resection.METHODS A cohort of 93 patients were recruited in our randomized clinical trial and were divided into two different groups in a randomized manner. Forty-two patients(group A) underwent Khubchandani's procedure with stapled posterior rectal wall resection and 51 patients(group B) underwent the STARR procedure.Follow-up was performed at 1, 3, 6, and 12 mo after the operation. Preoperative and postoperative ODS scores and depth of rectocele, postoperative complications, blood loss, and hospital stay of each patient were documented. All data were analyzed statistically to evaluate the efficiency and safety of our procedure.RESULTS In group A, 42 patients underwent Khubchandani's procedure with stapled posterior rectal wall resection and 34 were followed until the final analysis. In group B, 51 patients underwent the STARR procedure and 37 were followed until the final analysis. Mean operative duration was 41.47 ± 6.43 min(group A) vs39.24 ± 6.53 min(group B). Mean hospital stay was 3.15 ± 0.70 d(group A) vs 3.14± 0.54 d(group B). Mean blood loss was 10.91 ± 2.52 mL(group A) vs 10.14 ± 1.86 m L(group B). Mean ODS score in group A declined from 16.50 ± 2.06 before operation to 5.06 ± 1.07 one year after the operation, whereas in group B it was17.11 ± 2.57 before operation and 6.03 ± 2.63 one year after the operation. Mean depth of rectocele decreased from 4.32 ± 0.96 cm(group A) vs 4.18 ± 0.95 cm(group B) preoperatively to 1.19 ± 0.43 cm(group A) vs 1.54 ± 0.82 cm(group B)one year after operation. No other serious complications, such as rectovaginal fistula, perianal sepsis, or deaths, were recorded. After 12 mo of follow-up, 30 patients'(30/34, 88.2%) final outcomes were judged as effective and 4(4/34,11.8%) as moderate in group A, whereas in group B, 30(30/37, 81.1%) patients' outcomes were judged as effective, 5(5/37, 13.5%) as moderate, and 2(2/37,5.4%) as poor.CONCLUSION Khubchandani's procedure combined with stapled posterior rectal wall resection is an effective, feasible, and safe procedure with minor trauma to rectocele.
