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.     

金陵术治疗混合型便秘手术前后排粪造影的前瞻性对比研究

目的探讨混合型便秘患者接受金陵术（结肠次全切除、升结肠一直肠侧侧吻合术）治疗后出口梗阻病变的形态学及功能学改善程度。方法前瞻性选取2009年3月至2010年12月间南京军区总医院普通外科行金陵术治疗的混合型便秘患者50例．分别于术前1周及术后6个月行排粪造影检查,并采用Longo出口梗阻评分、Wexner便秘严重度评分及Wexner粪便失禁评分评估便秘症状。结果金陵术后6个月,50例患者直肠前突、黏膜脱垂、黏膜内套叠、内脏下垂、会阴下降及盆底痉挛的发生率均较术前显著下降（P〈0．01）。直肠前突程度由术前的（22．0±1．8）mm下降至（2．4±0．4）mm,直肠内套叠程度南术前的（1．9±0．4）cm下降至（0．4±0．5）cm（P〈0．01）。Longo出口梗阻评分由术前的（17．6±3．8）分下降至（5．3±2．0）分,Wexner便秘严重度评分由（19．5±4．8）分下降至（5．5±2.4）分（均P〈0．01）。结论金陵术能有效纠正混合型便秘的出口梗阻病变的形态及功能紊乱．从而改善便秘症状。     

PPH手术治疗出口梗阻型便秘的临床研究

目的探讨PPH治疗出口梗阻型便秘术临床疗效。方法出口梗阻型便秘的患者均通过体检和排粪造影确诊。采用排便梗阻症状评分以及Wwxner评分分别评估术前和术后症状,判断手术疗效。结果手术后3个月,ODS评分从15.2±8.9（SD）分下降到5.4±0.5（SD）分,梗阻症状明显改善。结论 PPH手术治疗出口阻塞性排便困难安全、有效。     

STARR术治疗出口梗阻型便秘短期疗效观察及术后急便感作用靶点探讨

为探讨经肛吻合器直肠切除术(STARR)治疗直肠黏膜内套叠引起的出口梗阻型便秘的短期疗效及术后急便感的可能作用靶点,回顾性分析89例行STARR术治疗的出口梗阻型便秘患者临床资料,评估手术前后Longo便秘评分及术后并发症情况.将术后出现急便感的患者与组内未出现急便感患者进行个体匹配(1:1),检测患者直肠黏膜组织中T...     

PPH治疗直肠前突所致出口梗阻型便秘的临床研究

目的观察PPH治疗直肠前突所致出口梗阻型便秘的临床疗效。方法将30例直肠前突所致出口梗阻型便秘随机分为治疗组15例,采用PPH术;对照组15例,采用经直肠切开修补术（Sehapayah法）,观察两组患者治愈率及术后并发症。结果治疗组与对照组治愈率分别为80%和73%,无明显差异（P〉0.05）,但两组间的术后疼痛程度、创口愈合天数存在显著差异（P〈0.01）。结论在治疗直肠前突所致出口梗阻型便秘时,PPH术与传统经直肠切开前突修补术相比,具有手术操作简单,术后并发症少,恢复时间短,安全性高等优点,但治疗直肠前突其远期疗效尚有待进一步观察。     

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。     

经肛门手术治疗出口梗阻型便秘研究进展

出口梗阻型便秘（OOC）是便秘中最常见的类型之一,该疾病的病因复杂,且治疗的最佳时机常被延误,患者的生活质量严重受损。保守治疗效果不甚理想;手术方式多以经肛门直肠手术为主,且随着临床广泛应用,出现的术后并发症增多,长期疗效也有待提高。经过外科医务工作者对治疗OOC的术式不断改进,经肛门直肠手术联合硬化注射被多方证实安全有效,值得推广。     

经肛吻合器直肠切除术治疗出口梗阻型便秘的并发症分析

目的评价经肛吻合器直肠切除术（STARR）治疗出口梗阻型便秘（ODS）的安全性。方法回顾性分析2007年1月至2008年10月间第二炮兵总医院采用STARR治疗112例直肠前突和（或）直肠内套叠相关性ODS女性病例的临床资料．统计围手术期及术后远期并发症发生情况。结果术后早期发生并发症18例（16．1％）,包括肛门失禁（4．5％）、吻合口出血（2．7％）、吻合口部分裂开（0．9％）、肛裂（2．7％）、急性尿潴留（1．8％）、血栓性外痔（1．8％）、直肠阴道隔血肿（0．9％）、粪便嵌塞（0．9％）,其中2例患者（1．8％）因并发症需再次手术干预。术后中位随访24个月,远期发生并发症6例（5．4％）,包括：肛门失禁（1．8％）、排粪急迫感（0．9％）、吻合口周围炎致慢性疼痛（1．8％）、直肠憩室致慢性疼痛（0．9％）,其中3例患者（2．7％）需手术治疗。结论STARR是治疗出口梗阻型便秘相对安全的术式。     

改良双PPH治疗女性出口梗阻型便秘40例

为观察改良双PPH治疗女性出口梗阻型便秘的临床疗效,回顾分析采肘改良双PPH治疗以直肠前突和（或）直肠黏膜内脱垂为主的出口梗阻型便秘40例的临床资料。结果显示．奉组治愈36例,好转4例,治愈率为90％,有效率为100％。随访6个月至1年．均无复发．无肛门失禁、直肠狭窄及直肠阴道瘘发生。结果表明．改良双PPH治疗女性出口梗阻型便秘安全、有效,具有操作简便、创伤小等优点。远期效果有待进一步观察。     

PPH治疗出口梗阻型便秘50例疗效观察

为探讨吻合器痔上黏膜环切术（PPH）治疗出口梗阻型便秘的疗效,对50例出口梗阻型便秘患者行PPH治疗。50例患者均合并中、重度痔,除痔外,单纯合并直肠黏膜内脱垂27例,合并中、重度直肠前突加直肠黏膜内脱垂18例,合并耻骨直肠肌综合征并直肠黏膜内脱垂5例。结果显示,本组治愈42例。好转5例,无效3例,有效率为94．0％。无效的3例均为重度卣肠黏膜内脱垂合并耻骨直肠肌肥厚者。结果表明,PPH治疗以直肠前突和直肠黏膜内脱垂为主的出口梗阻型便秘疗效显著,但对耻骨直肠肌综合征引起的出口梗阻型便秘单纯行PPH矫治疗效欠佳。     

经肛吻合器直肠切除术在出口梗阻型便秘治疗中的应用

目的 评估经肛吻合器直肠切除术治疗出口梗阻型便秘的疗效及安全性.方法 2007年1月至2008年8月对56例经排粪造影证实存在直肠前突和(或)直肠套叠脱乖的出口梗阻型便秘患者,行吻合器经肛直肠切除手术,比较术前和术后临床症状缓解情况,并量化评分比较.结果 手术时间平均28 min,术后3 d内VAS疼痛评分平均3.2分.2例患者术后随访6个月,有轻度肛门失禁;2例患者分别随访2、4个月,吻合口有轻度炎症,致排便时肛门部轻度疼痛.无其他并发症发生.术后平均随访8个月,各项出几梗阻症状发牛率较术前均显著下降,尤其是排便困难及排便梗阻感的发生率均下降50%以上,差异均有统计学意义(P<0.05).量化评分后比较,术后便不尽感积分较术前下降65%,其余症状积分下降幅度均达72%以上,差异均有统计学意义(P<0.05).结论 经肛吻合器直肠切除术治疗出口梗阻型便秘操作简单、创伤小、痛苦少、并发症少,近期疗效较满意.     

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.     

Therapeutic effects of the TST36 stapler on rectocele combined with internal rectal prolapse

BACKGROUNDThe most common causes of outlet obstructive constipation (OOC) are rectocele and internal rectal prolapse. The surgical methods for OOC are diverse and difficult, and the postoperative complications and recurrence rate are high, which results in both physical and mental pain in patients. With the continuous deepening of the surgeon’s concept of minimally invasive surgery and continuous in-depth research on the mechanism of OOC, the treatment concepts and surgical methods are continuously improved.AIMTo determine the efficacy of the TST36 stapler in the treatment of rectocele combined with internal rectal prolapse.METHODSFrom January 2017 to July 2019, 49 female patients with rectocele and internal rectal prolapse who met the inclusion criteria were selected for treatment using the TST36 stapler.RESULTSForty-five patients were cured, 4 patients improved, and the cure rate was 92%. The postoperative obstructed defecation syndrome score, the defecation frequency score, time/straining intensity, and sensation of incomplete evacuation were significantly decreased compared with these parameters before treatment, and the differences were statistically significant (P < 0.05). The postoperative anal canal resting pressure and maximum squeeze pressure in patients decreased compared with before treatment, and the differences were statistically significant (P < 0.05). The initial and maximum defecation thresholds after surgery were significantly lower than those before treatment, and the differences were statistically significant (P < 0.05). The postoperative ratings of rectocele, resting phase, and defecation phase in these patients were significantly decreased compared with those before treatment, and the differences were statistically significant (P < 0.05).CONCLUSIONThe TST36 stapler is safe and effective in treating rectocele combined with internal rectal prolapse and is worth promoting in clinical work.     

A prospective evaluation of occult disorders in obstructed defecation using the ''iceberg diagram''

OBJECTIVE: Surgical treatment of constipation and obstructed defecation (OD) carries frequent recurrences, as OD is an 'iceberg syndrome' characterized by 'underwater rocks' or occult diseases which may affect the outcome of surgery. The aim of this study was to evaluate occult disorders in order to alert the clinician of these and minimize failures. METHOD: One hundred consecutive constipated patients with OD symptoms, 81 female patients, median age 52 years, underwent perineal examination, proctoscopy, anorectal manometry, and anal/vaginal ultrasound. Anorectal physiology and imaging tests were also carried out when indicated, as well as psychological and urogynaecological consultation. Symptoms were graded using a modified 1-20 constipation score. Both evident (e.g. rectocele) and occult (e.g. anismus) diseases were prospectively evaluated using a novel 'iceberg diagram'. The type of treatment, whether conservative or surgical, was also recorded. RESULTS: Fifty-four (54%) patients had both mucosal prolapse and rectocele. All patients had at least two occult OD-related diseases, 66 patients had at least three: anxiety-depression, anismus and rectal hyposensation were the most frequent (66%, 44% and 33% respectively). The median constipation score was 11 (range 2-20), the median number of 'occult disorders' was 5 (range 2-8). Conservative treatment was carried out in most patients. Surgery was carried out in 14 (14%) patients. CONCLUSION: The novel 'iceberg diagram' allowed the adequate evaluation of OD-related occult diseases and better selection of patients for treatment. Most were managed conservatively, and only a minority were treated by surgery.     

A prospective evaluation of occult disorders in obstructed defecation using the ''iceberg diagram''

OBJECTIVE: Surgical treatment of constipation and obstructed defecation (OD) carries frequent recurrences, as OD is an 'iceberg syndrome' characterized by 'underwater rocks' or occult diseases which may affect the outcome of surgery. The aim of this study was to evaluate occult disorders, in order to alert the clinician of these and minimize failures. METHOD: One hundred consecutive constipated patients with OD symptoms, 81 women, median age 52 years, underwent perineal examination, proctoscopy, anorectal manometry and anal/vaginal ultrasound (US). Anorectal physiology and imaging tests were also carried out when indicated, as well as psychological and urogynaecological consultations. Symptoms were graded using a modified 1-20 constipation score. Both evident (e.g. rectocele) and occult (e.g. anismus) diseases were prospectively evaluated using a novel 'iceberg diagram'. The type of treatment, whether conservative or surgical, was also recorded. RESULTS: Fifty-four (54%) patients had both mucosal prolapse and rectocele. All patients had at least two occult OD-related diseases, 66 patients had at least three of them: anxiety-depression, anismus and rectal hyposensation were the most frequent (66%, 44% and 33%, respectively). The median constipation score was 11 (range 2-20), the median number of 'occult disorders' was 5 (range 2-8). Conservative treatment was carried out in most cases. Surgery was carried out in 14 (14%) patients. CONCLUSION: The novel 'iceberg diagram' allowed the adequate evaluation of OD-related occult diseases and better selection of patients for treatment. Most were managed conservatively, and only a minority were treated by surgery.