吻合器经肛直肠切除术与经直肠闭式修补术治疗直肠前突的对照研究

目的 比较吻合器经肛直肠切除术（stapled transanal rectal resection,STARR）与经直肠闭式修补术（Block）治疗直肠前突的临床疗效.方法 2008年1月至2012年1月期间手术治疗67例直肠前突患者,根据手术方式的不同分为STARR组（36例）和Block组（31例）,对两组患者手术后症状改善情况进行Longo＆#39;s 排便障碍综合征（obstructed defecation syndrome,ODS）评分,并对手术时间、术中出血量、术后并发症、住院时间及住院费用进行比较.结果两组患者术后排便困难症状均有明显改善.Longo＆#39;s ODS评分,STARR组术后1个月与术后3个月、12个月比较,差异均无统计学意义（P＆gt;0.05）,Block组术后3个月、12个月明显高于术后1个月（P＆lt;0.05）.STARR组与Block组的手术时间、术中出血量、术后并发症发生率及住院时间方面比较,差异均无统计学意义（P＆gt;0.05）;但STARR组的治疗费用明显高于Block组（P＆lt;0.05）.结论 STARR术式治疗直肠前突虽然比Block术式费用高,但远期疗效优于Block手术.     

经肛吻合器直肠黏膜切除术与经直肠闭式修补术治疗直肠前突的对比研究

目的比较经肛吻合器直肠黏膜环形切除术(procedure for prolapse and hemorrhoids,PPH)与经直肠闭式修补术(Block)治疗直肠前突的临床疗效。方法对2008年9月至2010年9月期间我院手术治疗的62例直肠前突患者的临床资料进行回顾性分析,根据手术方式的不同分为PPH组(n=32)和Block组(n=30)。对2组患者手术后症状改善情况进行Longo’s出口梗阻型便秘(ODS)评分,并对手术时间、术中出血量、术后疼痛评分、需用止痛药次数、术后并发症、住院时间及住院费用进行比较。结果 2组患者术后排便困难症状均有明显改善。Longo’sODS评分PPH组术后1个月与术后3个月比较,差异无统计学意义(P>0.05),Block组术后3个月明显高于术后1个月(P<0.01)。2组患者术后1个月和术后3个月Longo’s ODS评分、手术时间、术中出血量、术后疼痛评分、需用止痛药次数及住院时间方面PPH组均明显少于Block组(P<0.01);但PPH组的治疗费用明显多于Block组(P<0.01)。在PPH组患者中,术后出现2例轻度肛门失禁,随访至术后3个月时完全恢复。结论 PPH治疗直肠前突与Block一样安全、有效,从近期疗效上看,优于Block手术且复发率较低。     

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.     

两种术式治疗直肠前突疗效比较

目的通过经阴道修补直肠前突术和PPH术治疗直肠前突疗效比较,探讨两种术式治疗直肠前突方面的优缺点。方法对2004～2011年采用经阴道修补直肠前突术式(A组)和PPH术式(B组)治疗直肠前突各30例,在有效例数、手术时间、术中出血量、住院时间、住院费用、恢复工作时间、术后疗效等指标作对比分析。结果 PPH术式在手术时间、术中出血量、住院时间、恢复工作时间等方面优于经阴道修补直肠前突术式,两种术式有效率相近。结论 PPH术式治疗直肠前突是一种有效方法,手术简单,疗效好。     

STARR术治疗直肠黏膜内脱垂合并直肠前突50例

目的:观察经肛吻合器直肠切除术(STARR)治疗直肠黏膜内脱垂合并直肠前突的临床疗效。方法:将2019年10月至2021年12月，本院100例直肠黏膜内脱垂合并直肠前突患者随机分为观察组和对照组，每组50例。观察组采用STARR术治疗，对照组采用PPH治疗，观察比较2组术后1周临床疗效、排便情况、住院时间及术后并发症情况。结果:观察组总有效率明显高于对照组(P<0.05);排便通畅情况优于对照组；2组术后1周各出现便血1例，均无直肠阴道瘘及吻合口狭窄。2组术中出血量、疼痛评分及住院时间比较，差异无统计学意义(P>0.05)。结论:STARR术治疗直肠黏膜内脱垂合并直肠前突疗效确切，术后排便通畅情况较好，且未增加术后并发症发生概率，值得临床推广应用。     

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.     

选择性吻合器经肛门直肠黏膜部分切除术治疗直肠黏膜脱垂效果观察

目的 探讨选择性吻合器经肛门直肠黏膜部分切除术(TST STARR+术)治疗直肠黏膜脱垂的临床效果。方法 回顾性分析2018-03—2020-03罗山县人民医院急诊科收治的80例直肠黏膜脱垂患者的临床资料。按手术方法分为T组与d组,每组40例。d组实施双吻合器痔上黏膜环切钉合术(dPPH),T组行TST STARR+术治疗。比较2组患者的基线资料、手术指标。术后第1天采用视觉模拟评分法(VAS)评估患者的疼痛程度。统计术后1个月内的并发症发生率。结果 2组患者的基线资料差异无统计学意义(P>0.05)。T组患者的手术时间、术中出血量、吻合口缝合次数、切除标本容积均优于d组,术后第1天的VAS评分和术后1个月内的并发症发生率均低于d组。以上差异均有统计学意义(P<0.05)。结论 TST STARR+术治疗直肠黏膜脱垂患者,有助于缩短手术时间,减少术中出血量与吻合口缝合次数,并具有术后疼痛程度轻和并发症发生率低的优势。     

经肛门手术治疗直肠全层脱垂

目的：探讨经肛门入路手术方式治疗直肠全层脱垂的疗效。方法直肠全层脱垂38例,28例行经肛门直肠乙状结肠部分切除术（Altemeier术）;8例行经肛门吻合器直肠切除术（STARR术）;2例行改良经肛门吻合器直肠切除术（TST STARR Plus术）。结果切除直肠全层标本长度：Altemeier术8～30 cm,STARR术及TST STARR Plus术4～6 cm。术中并发症：STARR术及TST STARR Plus术各发生吻合器切割后钉合不全1例,给予3-0可吸收线缝合。术后近期并发症：无一例发生吻合口瘘,无一例术后严重早期并发症,2例Altemeier、1例STARR患者术后1周内出现吻合口出血,保守治疗成功。术后平均住院时间为6 d（5～8 d）。中位随访时间38个月（1～47个月）,每日排大便次数1～3次,1例患者行Altemeier术后12．5个月复发,1例Altemeier术后吻合口狭窄给予多次扩肛后完全缓解。随访期间所有患者术后性功能未受影响。结论 Altemeier术是治疗＞5 cm的直肠完全脱垂的可靠术式;STARR术和TST STARR Plus术可用于治疗长度＜5 cm的直肠完全脱垂,但STARR术特别是TST STARR Plus术的远期疗效尚需进一步研究证实。     

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。     

经肛吻合器直肠切除术治疗直肠前突疗效观察

目的观察经肛吻合器直肠切除术治疗直肠前突的临床疗效。方法随机将需手术治疗的56例直肠前突患者分为对照组26例和观察组30例。对照组给予经肛门直肠修补术,观察组采用经肛吻合器直肠切除术,观察两组疗效。结果观察组疗效优于对照组(P0.05)。观察组在手术时间、术中出血量及住院时间方面均显著优于对照组(P0.05)。对照组并发症的发生率显著高于观察组(P0.05)。两组比较,差异有统计学意义。结论经肛吻合器直肠切除术具有手术时间短,术中出血量少及恢复快等优势,值得临床推广应用。     

Short-term results after STARR versus internal Delorme for obstructed defecation: a non-randomized prospective study

Obstructed defecation syndrome due to internal intussusception and rectocele is a common disease, and various transanal surgical techniques have been proposed. Aim of the present study was to compare the internal Delorme (ID) and the stapled transanal rectal resection (STARR) results in the treatment of patients with obstructed defecation syndrome. From September 2011 to May 2012, 23 patients were operated with STARR procedure and 12 patients with Delorme’s procedure for obstructed defecation syndrome. All patients underwent preoperative assessment: clinical evaluation (Altomare ODS score, Wexner constipation scoring system), proctoscopy, defecography, anorectal manometry and endoanal ultrasonography. Surgery was proposed with: failure of medical therapy, incomplete defecation, and unsuccessful attempts with long periods spent in bathroom, defecation with digital assistance, use of enemas and defecography findings of rectoanal intussusception and rectocele. The average operative time was 28 min (range 15–65) for the STARR group and 56 min (range 28–96) for the ID group with a mean hospital stay of 2 days for both the procedures. The Wexner score significantly fell postoperatively from 17 to 4, 7 in STARR group and from 15.3 to 3.3 in the ID group. The Altomare score postoperatively fell from 18.2 to 5.5 for STARR group and from 16.5 to 5.3 for ID group. No statistically significant differences were observed between the two procedures considering the outcomes parameters and the complications. Both ID and STARR procedure seem to be effective in the treatment of ODS.     

STARR手术治疗排便障碍综合征的临床研究

目的探讨STARR手术治疗排便障碍综合征（ODS）的临床疗效及并发症。方法将60例ODS患者随机分为治疗组、对照1组和对照2组,每组20名患者。治疗组采用STARR手术,对照1组采用PPH术,对照2组采用经阴道直肠前突修补术（荷包法）。观察、比较3组患者手术时间、出血量、住院时间、并发症、治疗效果等指标。结果治疗组与对照1组术后ODS评分、有效率、手术时间差异有统计学意义;治疗组手术时间、出血量少于对照2组的相关指标,差异有统计学意义。结论STARR手术治疗排便障碍综合征疗效肯定。     

TST吻合器经肛直肠部分切除术治疗直肠套叠的近期疗效观察

目的初步探讨TST吻合器经肛直肠部分切除术治疗直肠套叠的安全性及近期疗效。方法我院及武汉大学中南医院2014年1月至2014年8月共收治13例直肠套叠的患者均行TST吻合器经肛直肠部分切除术,记录分析缝扎止血情况、标本高度、手术时间、住院周期及术后并发症的发生情况。结果平均随访2个月,10例患者脱垂超过肛门扩张器长度的一半,平均手术时间35.2min,切除标本平均高度4.5cm,平均住院周期7d,本组患者吻合口均加固缝合,术中吻合不全出血1例缝扎止血,术后2例出血保守治疗愈合,2例术后2周内仍便急,无重大手术并发症。结论 TST吻合器经肛直肠部分切除术治疗直肠套叠安全,近期疗效可靠。     

Quo Vadis STARR? A Prospective Long-Term Follow-Up of Stapled Transanal Rectal Resection for Obstructed Defecation Syndrome

Introduction  

Functional and clinical long-term outcome after stapled transanal rectal resection (STARR) in patients with an isolated symptomatic rectocele are investigated. Short-term results after 1 year are comparable with the functional outcome even after 5 years. Eighty per cent of the patients were still satisfied. STARR is an alternative procedure to the conventional surgical approaches for patients with an obstructed defecation syndrome and rectocele. Several studies have reported short-term outcome after STARR, but long-term results are still missing. The objective of this study was to evaluate long-term clinical outcome after STARR with a follow-up of 5 years.     

Transanale Verfahren bei funktionellen Darmerkrankungen

The transanal operative procedure for the treatment of obstructive defecation syndrome (ODS) can be secondarily applied in cases of failure or ineffectiveness of conservative treatment. Clinically established transanal procedures are rectocele resection (RR), mucosectomy for internal rectal prolapse according to the Rehn-Delorme procedure (MR) and stapled transanal rectal resection (STARR Contour Transtar). Only few studies have indicated the value of RR and MR in the treatment of obstructive diseases and in general study quality and evidence level are low. There might be an indication in rectocele-associated symptoms, such as incomplete evacuation, straining and digitation. In contrast the STARR procedure has been well characterized by a large number of high quality studies providing an elevated evidence level for the treatment of ODS. Functional results are available with a follow-up of 1 year up to 68 months postoperatively. Response rates of up to 90% were reported whereas recurrence rates were given as a maximum of 18% at 68 months follow-up. In summary the STARR procedure provides good functional results for conservative refractory outlet obstruction with minor morbidity and outcome seems to remain stable in the long-term follow-up.     

Actual Role of Stapled Transanal Rectal Resection (STARR) for obstructed defecation syndrome

Internal rectal prolapse (rectal intussusception) and rectocele are frequent clinical findings in patients suffering from refractory constipation that may be best characterized as "obstructive defecation syndrome" (ODS). However, there is still no clear evidence whether the STARR procedure (stapled transanal rectal resection) provides a safe and effective surgical option for symptom resolution in ODS patients, as evidence-based guidelines and functional long-term results of representative collectives are still lacking. Based on published data derived from the German STARR registry, the STARR procedure can be performed safely with low morbidity. The definitive role of the STARR procedure has to be assessed by careful and prospective evaluation of long-term function, symptom resolution, and quality of life, e. g., as provided by the German STARR registry.     

吻合器经肛直肠切除术治疗出口梗阻型便秘的临床研究

为探讨吻合器经肛直肠切除术（STARR）治疗出口梗阻型便秘（OOC）的疗效,对2008年3月至2010年4月收治的36例符合罗马Ⅲ诊断标准的OOC患者应用STARR治疗,观察术后临床症状缓解情况和相关并发症,并进行量化评分比较。结果显示,平均手术时间为35min（25～45min）,平均术中出血20ml（10～50ml）。术后除2例患者出现暂时性排气失控、6例患者出现一过性急便感外,无其他手术并发症。术后排便频率、排便感、肛门坠胀感、排便方式、排便时间评分较术前均显著降低,P〈0．05。36例患者中,治愈25例,好转9例,无效2例,总有效率为94．4％（34／36）。术后随访3～24个月,平均14．3个月,随访期间无复发病例。结果表明,STARR治疗OOC操作简单、创伤小、并发症少,且近期疗效满意。     

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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.     

Assessing the safety, effectiveness, and quality of life after the STARR procedure for obstructed defecation: results of the German STARR registry

Background  

Internal rectal prolapse and rectocele are frequent clinical findings in patients with obstructed defecation syndrome (ODS). However, there is still no evidence whether stapled transanal rectal resection (STARR) provides a safe and effective surgical option. Therefore, the German STARR registry was initiated to assess safety, effectiveness, and quality of life.