STARR治疗中、重度直肠前突的应用研究(附15例报告)

目的探讨STARR手术治疗中、重度直肠前突的手术技巧、临床疗效及安全性。方法对15例中、重度直肠前突经STARR手术治疗后的临床资料进行分析、总结。结果全部病例排便困难症状明显缓解。结论 STARR治疗中、重度直肠前突是一种临床疗效显著、安全可靠的新方法。     

改良STARR手术治疗直肠前突25例临床观察

目的评价改良STARR手术治疗直肠前突的临床疗效。方法对25例直肠前突患者采用改良STARR手术治疗的临床资料作回顾性分析。结果术后随访6个月,痊愈21例,占84%,显效2例,占8%,有效2例,占8%,总有效率为100%。未发生重大并发症。结论改良STARR手术治疗直肠前突具有经济安全、创伤小、恢复快、并发症少的特点。     

STARR术在直肠前突治疗中的应用研究

目的探讨STARR术治疗直肠前突的临床疗效、安全性及术中技巧。方法将65例直肠前突患者随机分为两组,A组43例采用STARR手术,B组22例采用传统手术。对两组患者的临床资料进行分析总结。结果两组在有效率、手术时间、术后住院时间、术中出血量、总体满意度评分等方面比较差异有统计学意义（P〈0.05）。结论 STARR手术治疗直肠前突,临床疗效显著,安全可靠。     

直肠前突STARR术后肛肠动力学变化研究（附35例报告）

目的评价STARR手术治疗直肠前突的临床疗效及安全性。方法对35例直肠前突患者采用STARR手术,观察治疗前后排便情况,进行肛管测压并作对比分析。结果临床症状完全缓解17例,有效10例,无效8例,总有效率为77.1%。经治疗后盆底肌的矛盾运动消失,肛管静息压较术前下降（P〈0.05）,肛管舒张压较术前增高（P〈0.05）;直肠感觉阈值量、直肠最大耐受量、直肠最大顺应性比术前有所下降（P〈0.05）。结论根据肛肠动力学变化显示STARR手术治疗直肠前突疗效显著。     

中西医结合治疗直肠前突120例临床观察

目的:探讨经肛吻合器直肠切除术(STARR)结合中药治疗直肠前突的临床疗效。方法:采用吻合器对120例直肠前突患者实施STARR手术,结合辨证内服中药。结果:120例患者住院7~10 d,3个月后随治疗组总有效率为100%,12个月后随访,总有效率为99.17%。排便障碍情况均得到改善,全部有效。结论:STARR手术结合中药辨证治疗直肠前突型出口梗阻性便秘安全有效,操作简便。     

STARR手术治疗排便障碍综合征的临床疗效观察

目的探讨STARR手术治疗排便障碍综合征的临床效果和安全性。方法对23例排便障碍综合征患者采取STARR手术治疗的临床资料进行回顾性分析。结果术后20例患者临床症状缓解,其中19例患者直肠前突及直肠内脱垂得到改善,有效率87%。结论 STARR是一种安全有效的治疗排便障碍综合征的手术方法,术后并发症较少。     

改良STARR术治疗中、重度直肠前突的临床研究

目的对治疗中、重度直肠前突的三种不同手术方式进行比较和评价,为中重度直肠前突手术方式的选择提供依据。方法将120例中、重度直肠前突患者随机分成三组,A组(40例)采用改良STARR手术,B组(40例)采用常规STARR手术,C组(40例)采用经阴道切开修补术。分别观察分析三组患者手术情况、术后并发症及临床疗效。结果 A组在手术时间、术中出血、术后疼痛、术后坠胀、住院时间等方面优于C组。A组在术后坠胀、吻合口裂开等方面优于B组,A组在远期疗效方面优于B组及C组。结论改良STARR手术治疗中、重度直肠前突简便易行,术后并发症发生率低,近、远期疗效更佳。     

经肛吻合器直肠切除术治疗排便障碍

通过各种临床和实验研究,Longo推出了一种新的技术:经肛吻合器直肠切除术(stapled transanal rectal resection,STARR),即运用环行吻合器治疗导致排便障碍的一些疾病,包括直肠内脱垂和直肠前突引起的排便梗阻综合征。一、施行STARR手术的指征     

3种术式治疗直肠前突的疗效对比观察

目的 探讨不同术式治疗直肠前突的优缺点对比.方法 结合文献,分析2004～2007年采用Sehapayah术式(31例)、PPH术式(38例)、STARR术式(9例)治疗的78例直肠前突患者在手术时间、术中出血量、有效例数、住院时间、费用、恢复工作时间、术后并发症等指标的对比资料.结果 3种术式的有效率相似,Sehapayah术式手术时间长,术中出血量较多,STARR术式费用最高.结论 PPH术式治疗直肠前突是一种有效方法,手术简单,疗效确切,住院时间短、恢复快和术后疼痛轻.STARR术式治疗直肠前突近期疗效确切,但开展时间短,手术例数少,有待于进一步积累资料.     

STARR术结合中药辨证治疗直肠前突型便秘20例

目的：探讨STARR手术结合中药辨证治疗出口梗阻性便秘的临床疗效。方法：采用吻合器对20例出口梗阻性便秘患者实施STARR手术,结合辨证内服中药。结果：20例患者住院5~7d,随访3~12个月,排便障碍情况均得到改善,全部有效。结论：STARR手术结合中药辨证治疗直肠前突型出口梗阻性便秘安全有效,操作简便。     

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??Stapled transanal rectal resection in the treatment of rectocele and rectal intussusception DING Jian-hua, ZHAO Ke. Department of Colorectal Surgery, Colorectal Disease Center of PLA, the Second Artillary General Hospital, Beijing 100088, China
Corresponding author: ZHAO Ke, E-mail:jianhuading75@163.com
Abstract Stapled transanal rectal resection (STARR) has been introduced as a novel surgical approach for obstructed defecation syndrome caused by rectocele and rectal intussusception. Many reports have suggested the short-term success rate after STARR varies between 67% and 94%. Midterm outcome reveals 4.3%-17.1% of symptom recurrence rate. However, the improvement declines slightly according to the long-term results. The main complication after STARR is fecal incontinence which involves about 8.8% to 10.7% of patients. Defecography research proves that STARR procedure correct both rectocele and rectal intussusception significantly. The symptom improvement is related with the defecography results after the operation. Decreased maximum tolerable volume is reported after STARR according to anorectal manometry. The defecography results are valuable to predict the outcome after STARR.     

STARR术与Bresler术治疗出口梗阻型便秘的短期疗效比较

目的 比较STARR术与Bresler术治疗出口梗阻型便秘（ODS）的短期疗效.方法 回顾性分析并比较由直肠前突和/或直肠内脱垂引起的女性出口梗阻型便秘患者行STARR手术或者Bresler手术的临床资料各30例.结果 STARR术平均手术时间14～31 min,平均（23±4）min,术中出血量5～15 ml,平均（10±3）ml.术后住院时间4～7d,平均5d.术后2例直肠肛门疼痛,其中l例持续至术后6个月;5例轻度大便失禁（肛门失禁评分小于3）,均自行恢复;1例吻合口轻度出血.术后均随访6个月,临床疗效评估满意度为76％.Bresler术平均手术时间15～30 min,平均（22±5）min,术中出血量5～15 ml,平均（10 ±2） ml.术后住院时间4～6d,平均5d.术后3例直肠肛门疼痛,其中1例持续至术后6个月;4例轻度大便失禁（肛门失禁评分小于3）,均自行恢复;2例直肠切割线轻度出血.术后均随访6个月,临床疗效评估满意度为73％.两种手术方式在平均手术时间、术中出血量、术后平均住院时间以及短期临床效果评估上差异均无统计学意义（P＞0.05）.结论 对经严格筛选的ODS患者,两种手术方式短期治疗效果相当,但二者长期疗效比较尚需进一步论证.     

加味补中益气汤配合针刺治疗直肠前突术后的临床观察

目的:观察加味补中益气汤配合针刺治疗直肠前突术后的中、远期疗效。方法:选取符合纳入标准的直肠前突患者120例,随机分为治疗组和对照组各60例。治疗组行经肛吻合器直肠切除术(STARR)术后联合加味补中益气汤及针刺治疗,对照组仅行STARR术后单纯口服加味补中益气汤治疗,观察并比较两组术后3个月及1年的临床疗效。结果:治疗3个月后,治疗组的总有效率为98.33%,高于对照组的88.33%;1年后治疗组的总有效率为98.33%,高于对照组的86.67%,差异均有统计学意义(P<0.05)。结论:加味补中益气汤配合针刺治疗用于直肠前突术后患者,远期效果显著。     

Cost-revenue analysis in the surgical treatment of the obstructed defecation syndrome

The obstructed defecation syndrome is a frequent condition in the female population. Rectocele and rectal intussusception may cause symptoms of obstructed defecation. The aim of this study is to carry out an economic cost-revenue analysis comparing the rectocele and the rectal intussusception surgical techniques using a double-transanal, circular stapler (Stapled Trans-Anal Rectal Resection - STARR) with other techniques used to repair the same defects. The analysis involved the systematic calculation of the costs incurred during hospitalisation. The revenue estimate was obtained according to the rate quantification of the Diagnosis Related Group (DRG) associated with each hospitalisation. Our analysis confirmed that the global expenditure for the STARR technique amounts to 3,579.09 Euro as against 5,401.15 Euro for rectocele abdominal repair and 3,469.32 Euro for perineal repair. The intussusception repair cost according to Delorme's procedure amounts to 5,877.41Euro as against 3,579.09 Euro for the STARR technique. The revenue analysis revealed a substantial gain for the Health Authority as regards the treatment of rectocele and rectal intussusception for obstructed defecation syndrome. The highest revenue, 6,168. 52 Euro, was obtained with intussusception repair with STARR as compared to Delorme's procedure which presented revenue amounting to 2,359.04. Lower revenues are recorded if the STARR technique is intended for rectocele repair; in this case the revenue amounts to 1,778.12 Euro as against 869.67 Euro and 1,887.89 Euro for abdominal and perineal repair, respectively.     

Stapled Transanal Rectal Resection (Starr) to Reverse the Anatomic Disorders of Pelvic Floor Dyssynergia

Anterior rectocele and rectoanal intussusception are anatomic disorders related to excessive straining during defecation that usually manifest with symptoms of obstructive defecation. Stapled transanal rectal resection (STARR), a newly described surgical method for correcting these disorders, is considered a good alternative to the traditional transrectal approaches. The aim of the present study was to assess the early postoperative functional results of STARR. A total of 16 patients (13 female) were subjected to the STARR procedure during a period of 12 months. The presence of anatomic disorders of the anorectum was verified by dynamic defecography. Preoperative assessment also included colonic transit time, anal sphincter ultrasonography, and anorectal stationary manometry. Postoperative assessment included the same battery of tests. Altogether, 12 patients had rectoanal intussusception of > 2 cm and rectocele. In eight of them the anterior component of the rectocele was 2 to 4 cm, and in four it was > 4 cm. Four patients had a 1- to 2-cm internal intussusception and a rectocele of < 2 cm. All of them reported evacuation difficulties, but none had significant incontinence. Preoperative endoscopy did not reveal the presence of a solitary ulcer in any of the patients. All females had had normal vaginal deliveries, and four of them were multiparous. No complications were encountered postoperatively, and the need for analgesics was minimal. At defecography, rectoanal anatomy was seen to be restored in all patients. Obstructive defecation symptoms remained rather unaffected in seven, disappeared in three, and improved significantly in the remaining six patients. The seven failures showed anismus at manometry and had biofeedback treatment with satisfactory results in five of them. Failure of the operation and biofeedback sessions to treat symptoms in those two cases was attributed to coexisting enterocele, which had been missed preoperatively. Immediately after surgery, most of the patients complained of urgency and frequent small motions that resolved spontaneously within 3 to 5 weeks in all but two cases. STARR is a safe, well tolerated surgical procedure that effectively restores anatomy and function of the anorectum in patients with anterior mucosal prolapse and rectoanal intussusception. Additional biofeedback treatment is usually necessary for further functional improvement. Failure may be the result of other coexisting anatomic and functional abnormalities of the pelvic floor.     

Stapled transanal rectal resection (STARR): a new option in the treatment of obstructive defecation syndrome

Background Rectocele and distal intussusception are organic causes of outlet obstruction. A new surgical option called the stapled transanal rectal resection (STARR) is described within a prospective study. Patients and methods Fourteen patients with symptomatic rectocele (four females), rectocele with coexistent intussusception (eight females), and intussusception (two males) underwent STARR procedure. The symptoms were measured by means of a defecation score (0–20 points). Results Complications included local bleeding postoperatively in two cases, and temporary ischuria in four cases. The subjective sense of pain was low; from day 1 postoperatively five patients did not need any analgetics. Only one female patient had prolonged pelvic pain, without any organic reason. All patients showed improvement in rectal evacuation. The mean score of defecation (0–20 points) decreased from 13±3 to 4±3 after 1 month (p<0.05) and remained low. The overall follow-up was 19±9 months. Only one male patient with intussusception had defecation disorder again 6 months after surgery. Three patients had temporary urge incontinence. Conclusion STARR is an effective therapy for obstructive defecation disorder due to a symptomatic rectocele and/or a distal intussusception.