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。     

STARR术与Block术加注射液局部注射治疗直肠前突的疗效对比研究

目的对比STARR术和Block术加局部注射治疗直肠前突的临床疗效。方法根据不同的手术途径将其随机分为STARR术组(A组)35例和Block术加芍倍注射液局部注射组(B组)35例。对两组的患者手术情况和手术疗效进行对比。结果 A组手术时间、术中出血量、术后疼痛评分和止痛药使用次数明显优于B组(P0.01);术后12个月症状改善情况、便秘评分A组优于B组(P0.05)。结论 STARR术后手术时间短、术中出血量少、术后疼痛轻和止痛药使用次数少,更适合直肠前突手术的治疗。     

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.     

STARR手术在直肠前突治疗中的应用

目的探讨STARR手术治疗直肠前突的临床疗效、安全性及术中技巧。方法对10例直肠前突经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改善。结论STARR手术治疗直肠前突安全有效。     

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。     

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。     

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。     

PPH与STARR术治疗出口梗阻性便秘手术前后排粪造影的分析比较

目的 比较痔上黏膜环切术（PPH）和经肛吻合器直肠切除术（STARR）两种经肛门术式治疗出口梗阻性便秘的形态学及功能学变化.方法 自2009年3月开始,选择ODC接受手术的住院患者,根据不同手术途径分为PPH组（n=36）和STARR组（n=42）,前瞻性行排粪造影、Longo评分、Wexner评分等评价,对两组患者手术前、术后1周、术后3个月、术后6个月情况行追踪观察并对两组情况进行比较.结果 两组患者术后个人感觉及排粪造影检查、Longo评分、Wexner评分都较术前有好转,在直肠前突程度小于3.6 cm时,两组术中出血情况、影响生活时间上,术后并发症,术后3个月主观感觉、Longo评分、Wexner评分以及术后排粪造影均无明显区别（P＞0.05）,在直肠前突程度大于3.6 cm时,STARR组在Longo及Wexner评分优于PPH组（P＜0.05）,其他各项指标相似（P＞0.05）.STARR组手术时间、住院时间明显长于PPH组（P＜0.05）,住院费用明显高于PPH组（P＜0.05）.STARR组术中切除宽度大于PPH组（P＜0.05）.PPH组在术后1周主观感觉明显比STARR组好（P＜0.05）.结论 PPH及STARR术都为治疗ODS的良好术式,PPH和STARR在直肠前突程度较小时（＜3.6 cm）手术效果相似,但住院时间、花费费用较STARR少,因此较轻度的直肠前突可选择PPH术作为首选手术方式.     

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。     

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。     

Evaluation of the stapled transanal rectal resection technique with two staplers in the treatment of obstructive defecation syndrome

BACKGROUND: This study was designed to assess the safety and effectiveness of stapled transanal rectal resection (STARR) and to compare the results of two staplers. STUDY DESIGN: From February 2001 to June 2005, 37 patients diagnosed with obstructive defecation syndrome were treated with the STARR technique. We analyzed variables related to the patient, diagnosis based on anorectal exploration, surgical technique used, and clinical and radiologic results. We compared these results in patients with procedure prolapsed hemorrhoids (PPH)33-01 (group 1, n = 17) or PPH33-03 (group 2, n = 20). The patients were followed postoperatively at 1, 3, and 6 months, and annually. RESULTS: Intraoperative hemorrhage at the stapled suture occurred in 13 patients from group 1 and in 6 patients from group 2 (p = 0.03). The degree of postoperative pain was not different between the two groups. During the followup period, radiologic and clinical correction of the rectocele and intussusception was found in 94.6% of the patients, with a recurrence in 1 patient from each group. One patient from group 1 developed stenosis of the anastomosis, which improved with digital dilatations. Six patients from group 1 and none from group 2 (p < 0.05) had granulomas on the staple line at the sites of the reabsorbable reinforcing stitches, which were related to postoperative bleeding and anal discomfort. CONCLUSIONS: STARR is an effective alternative for treatment of obstructive defecation syndrome, with a low morbidity and a shorter hospital stay. The use of PPH33-03 instead of PPH33-01 decreases the risk of hemorrhagic complications and enables more secure implantation as an outpatient procedure.     

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.     

吻合器经肛直肠切除术与经阴道手术治疗直肠前突的比较

目的经肛吻合器直肠切除术(STARR)与桥式缝合术分别是经肛门、经阴道治疗直肠前突较新的术式,本研究拟对这两种术式进行比较。方法回顾性分析2007年1月至2009年5月期间因直肠前突排便困难接受手术的住院患者的临床资料,根据不同手术途径分为STARR组(n=18)和桥式缝合组(n=13),对2组患者手术后症状改善情况、手术时间、出血量、住院时间、费用、并发症等进行比较。结果STARR组排便困难显著改善11例,明显改善5例,桥式缝合组显著改善4例,明显改善2例,STARR组总改善率(88.9%)高于桥式缝合组(46.2%),P=0.017。STARR组平均手术时间为24.6min,平均出血量为3.9ml,平均住院费用为10743元;桥式缝合组平均手术时间为33.2min,平均出血量为16.2ml,平均住院费用为3543元,STARR组的这3项指标小于(多于)桥式缝合组(P0.01)。2组住院时间相近,STARR组术后有2例出现轻度肛门失禁,3个月后自然恢复。结论STARR对改善排便困难疗效优于阴道后壁桥式缝合术,但也有缺点,如费用高,术后短期内有的患者发生轻度肛门失禁,但能够自行恢复。     

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.     

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.     

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。     

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.