STARR手术治疗排便梗阻综合征临床疗效分析

目的评价经肛吻合器直肠切除术(STARR)治疗排便梗阻综合征(ODS)的临床疗效。方法回顾性分析行STARR手术治疗ODS 18例的临床资料。结果本组患者平均随访时间38个月(4~68个月),术前ODS评分从14.5±4.9到术后3个月降至5.9±5.0。随访期间,术后便秘症状改善61.1%(11例),无效16.7%(3例),术后复发22.2%(4例),其中2例再次行手术治疗,1例再次行STARR手术治疗,1例行结肠切除回直肠吻合,术后便秘症状改善。术后并发症:急便感11.1%(2例),肛门坠胀11.1%(2例),无术后出血、感染、直肠阴道瘘、直肠狭窄等重大并发症。随访期间未见肛门失禁。术后治疗满意度72.2%。结论 STARR手术治疗ODS安全有效,创伤小,恢复快,并发症少。     

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。     

TST-STARR术治疗老年女性出口梗阻型便秘的临床观察

探讨TST-STARR手术对治疗以直肠前突及直肠黏膜内脱垂为主的出口梗阻型便秘的临床疗效及术后并发症。对23例出口梗阻型便秘患者经TST-STARR手术治疗前后的临床资料进行分析总结。本组病例均一次手术成功,术后总有效率(95.1%),术后并发尿潴留7例(30.4%),便后少量带血3例(13.0%),有肛门疼痛需用止痛剂者5例(21.7%),均逐步缓解,术后Longo便秘评分明显降低,与术前差异有统计学意义(P0.05),肛门功能评估差异无统计学意义(P0.05),术后1个月全部病例排便困难症状均明显改善。TST-STARR手术治疗出口梗阻型便秘安全有效。     

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。     

经肛门直肠部分切除钉合术治疗出口梗阻型便秘

目的:探讨经肛门直肠部分切除钉合术(STARR)对出口梗阻型便秘的治疗效果。方法:回顾性分析37例接受STARR手术、24例接受传统手术的出口梗阻型便秘患者的临床资料,对比两组间性别构成、年龄、术前以及术后的Longo评分,评估两组的治疗效果。结果:术前Longo便秘评分STARR组为19.54±5.66、对照组为18.58±5.57,术后STARR组为6.54±3.56、对照组为9.63±3.56;术后两组Longo评分均降低,且STARR组较对照组降低更加显著。结论:STARR及传统手术均对改善出口梗阻型便秘的症状有效,STARR效果更加显著。     

肛门后方切开加改良Block修补术治疗直肠前突型便秘

目的探讨直肠前突型便秘的手术治疗效果。方法回顾性分析采用肛门后方切开加改良Block修补术治疗82例直肠前突型便秘的疗效。结果本组82例中采用肛门后方切开加改良Block修补术治疗直肠前突型便秘,手术总有效率为96%,其中痊愈率为67%,显效率为18%,有效率为11%。本组病例平均住院(18.8±4.8)d,无1例出现手术并发症。术后随访1～4年无便秘复发和大便失禁。结论该术式具有手术疗效确切、手术简便等特点,同时可于手术中一并处理并发的肛门疾病,可避免术后肛门狭窄。     

经阴道修补加直肠黏膜硬化剂注射治疗直肠前突的疗效观察（附56例报告）

目的探讨提高直肠前突所致出口梗阻型便秘的治疗效果。方法回顾性分析了我院采用经阴道修补加直肠黏膜硬化剂注射治疗直肠前突56例患者的临床资料。结果痊愈31例（55.4%）,显效10例（17.8%）,有效10例（17.8%）,无效5例（9%）,疗程平均21d。术后随访6～12个月,无并发症及后遗症。结论本方法临床疗效满意,值得临床推广。     

经会阴补片修补加耻骨直肠肌部分离断术治疗出口梗阻型便秘34例

为探讨经会阴补片修补加耻骨直肠肌部分离断术治疗出口梗阻型便秘的临床效果,对34例重度直肠前突伴耻骨直肠肌肥厚的出口梗阻型便秘患者行经会阴补片植入修补直肠前突加经肛周耻骨直肠肌部分离断术,并对疗效进行跟踪随访。结果显示,痊愈30例,显效3例,无效1例,总有效率为97．1％（33／34）。结果表明,经会阴补片修补加耻骨直肠肌部分离断术治疗出口梗阻型便秘操作简便,效果满意。     

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。     

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。     

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.     

Prevention of post-operative pain and haemorrhage in PPH (Procedure for Prolapse and Hemorrhoids) and STARR (Stapled Trans-Anal Rectal Resection). Preliminary results in 261 cases

Intra- and early (first week) post-operative haemorrhages are the most common complications in stapled hemorrhoidectomy PPH (Procedure for Prolapse and Hemorrhoids) and in circumferential resection of the rectal prolapse STARR (Stapled Trans Anal Rectal Resection). Performing PPH and STARR we employed a gelatin based haemostatic sealant with thrombin component (FloSeal) to control intra-operative bleeding and to reduce post-operative bleeding avoiding haemostatic stitches on suture line. We report the preliminary results on 197 PPH and 64 STARR; 44 PPH (22.4%) and 27 STARR (42.2%) were treated by FloSeal. No major post-operative bleeding was observed in all patients treated by FloSeal, compared to 1.3% and 2.7% of hemorrhage respectively in PPH and STARR patients treated without sealant. Post-operative pain was less severe in patients treated by FloSeal, without a difference statistically significant. The data are preliminary and must be confirmed in prospective randomized trials in larger series.     

Surgery for obstructed defaecation: does the use of the Contour device (Trans‐STARR) improve results?

Aim The objective of the study was to assess safety, efficacy and outcomes of stapled transanal rectal resection (STARR) procedure for obstructed defaecation syndrome (ODS) with two stapling devices, PPH01 and Trans‐STARR. Method Data were collected on all patients undergoing PPH01 or Trans‐STARR over a 2 year period. Initially, all were treated using the PPH01 device and during the last 8 months using the Trans‐STARR. Results During the analysis period, 25 consecutive patients were treated with PPH01 and 27 patients were treated with Trans‐STARR. The median follow up was 12 months (range 3–12 months) for the PPH01 group and 6 months (range 3–12 months) for the Trans‐STARR group. Although the resected specimen was larger in the Trans‐STARR group (P < 0.001), there was no difference in early adverse events, time to discharge or late complications between the groups. In both groups, postoperative urgency was common (occurring more than occasionally in up to 40% at last review) but the incidence was high preoperatively. ODS and symptom severity scores improved with surgery (P < 0.001). However, the degree of improvement was similar with complete resolution of symptoms occurring in 64% of the PPH01 group and 67% of the Trans‐STARR group. Conclusion Our study shows that both procedures are safe and effective in the surgical treatment of obstructed defaecation but despite a larger resection the Trans‐STARR procedure does not offer any additional benefit. A policy of individualizing techniques tailored to the extent of prolapse may be appropriate, but requires further evaluation.     

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。     

Medium‐term results of stapled transanal rectal resection (STARR) for obstructed defecation and symptomatic rectal‐anal intussusception

Aim Stapled transanal rectal resection (STARR) is an increasingly accepted treatment for obstructed defaecation syndrome (ODS) associated with internal rectal prolapse (IRP) and rectocoele. The aim of this study is to evaluate the medium to long‐term outcomes of STARR for ODS. Method The intermediate‐term results of STARR used over a 9 ‐year period were reviewed from the analysis of a prospectively maintained database. Patients were followed for a median period of 98 (95% CI 85–112, range 5–386) weeks. Results Three hundred and forty‐four (234 woman) patients of median age 54 (19–90) years underwent STARR over a 9‐ year period. Preoperative symptoms included pelvic pain (93%), incomplete evacuation (90%), urgency (74%), a sensation of obstruction (65%) and rectal digitation (27%). Thirteen had the solitary rectal ulcer syndrome. Of 326 patients with follow‐up data, 249 (76%) were followed beyond 1 year and 149 (43%) beyond 2 years. The ODS score improved [14.6 ± 5.4 pre vs 1.6 ± 3.1 post (P < 0.0001)] as did the faecal incontinence (FI) score [3.5 ± 3.3 pre vs 0.4 ± 1.3 post (P < 0.0001)]. Fifteen (4.3%) patients reported deterioration in FI, and 11 (3.2%) experienced new onset minor incontinence. Urgency was 72% at 8 weeks, 20% at 16 weeks, 11.5% at 52 weeks and 5% at 1.5 years. None of the 29 patients followed beyond 4 years reported urgency. Urgency was unrelated to sex, age or preoperative ODS symptoms (Mantel‐Cox log‐rank). Recurrent symptoms of ODS occurred in 4.9%. Eighty‐one per cent of patients were highly satisfied with STARR and would recommend or have it again. Conclusion STARR was successful for the treatment of selected patients with ODS and IRP. Postoperative faecal urgency rapidly decreases with time. It is not possible to predict who will develop urgency.     

Comparative study of contour transtar and STARR procedure for the treatment of obstructed defecation syndrome (ODS) – feasibility,morbidity and early functional results

Aim Stapled transanal rectal resection (STARR) is a promising new treatment for obstructed defecation syndrome (ODS). It may be performed using either a double‐stapling technique (PPH‐STARR) or with the new Contour Transtar (CT) device. The aim of this study was to evaluate the two techniques with respect to morbidity and functional outcomes. Method Patients presenting with ODS were evaluated using standardized clinical and radiological investigations and prospectively entered into a database. A total of 150 Patients were treated with either PPH‐STARR (n = 68) or CT (n = 82) and further evaluated at 12 month postoperatively. Results The mean size of the resected specimen was 27 cm² (SD ±4.86 cm²) in the PPH‐STARR group and 46 cm² (SD ±10.6 cm²) in the CT group [P < 0.001]. Morbidity was 7.3% (n = 5) in the PPH‐STARR group and 7.5% (n = 6) in the CT group. The most common complication was minor postoperative bleeding in both groups (PPH‐STARR: n = 2, 2.9%; CT: n = 2, 2.4%) Overall there were no septic complications and no surgical re‐interventions. There was a tendency for more postoperative pain following CT (n = 3, 3.6%) as compared with PPH‐STARR (n = 1, 1.4%). Constipation Scores (CCS) were 15.50 ± 5.71 in the PPH‐STARR group and 15.70 ± 5.84 in the CT group preoperatively and decreased significantly to 8.25 (SD ±1.45) and 8.01 (SD ±2.31) 12‐months after surgery. Values did not differ significantly between the two groups. Conclusions Contour Transtar is as safe and effective as PPH‐STARR and provides a true circumferential resection of rectal intussusception. This may benefit selected patients and result in improved long‐term durability of the technique.     

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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.     

Repair of rectocele using the Stapled TransAnal Rectal Resection (STARR) technique: intermediate results from a multicenter French study

BACKGROUND: Stapled transanal rectal resection is a new alternative for the treatment of outlet obstruction syndrome. The aim of this study was to assess its feasibility and safety in a multicenter context. MATERIALS AND METHOD: The study had a retrospective design and included 102 patients who were operated in 5 centers. All patients complained of symptomatic outlet obstruction. Surgical technique involved a double hemi-circumferential rectal stapling according to the technique described by Longo. Mean follow-up was 17.2 months. RESULTS: The STARR procedure was done in 100 patients (2 patients had a non relaxing sphincter preventing anal dilatation). Immediate postoperative morbidity included bleeding in 4 cases (4%) and rectal stenosis in 3 cases (3%). The main postoperative medium-term complaints were urge to defecate (34%) which was regressive in most patients and de novo incontinence to flatus (9%). Nevertheless, results were considered favorable in 85% of patients. CONCLUSION: This multicenter study, reporting the results of the largest published series, suggests that the STARR technique is feasible and safe in the medium term for the treatment of rectocele. Occurrence of adverse events such as incontinence to flatus should be better evaluated by future studies with longer follow up in order to assess the actual place of STARR in the treatment of rectocele or outlet obstruction.     

肛管减压松解术为主治疗出口梗阻型便秘

为探讨肛管减压松解术为主治疗出口梗阻型便秘的疗效,采用肛管减压松解术同时配合针对其病情的治疗方法治疗出口梗阻型便秘100例,结果痊愈85例,好转11例,无效4例,有效率96%.结果表明,以肛管减压松解术为主治疗出口梗阻型便秘疗效确切.