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.

A prospective center study of the contrast of Defecography pre-and post-PPH,pre-and post-STRAA for outlet defecation constipation

Objective To compare the anatomy and functional changes before and after PPH and STRAA by means of Defecography.Methods Seventy-eight patients with ODS in Jingzhou Hospital were divided into PPH group （n =36） and STARR group （n =42） acording to the different surgical treatment.They were compared before surgical,the first week after surgical,the third month after surgical,and the sixth month after surgical using Defecography,score of Longo,score of Wexner et al.Results The two groups of patients with personal feeling and defecography examination,Longo score,Wexner score was lower than the preoperative （P ＜0.05）.When the rectum anterior divergent degree is less than 3.6 cm,two groups have no obvious difference in intraoperative bleeding,affect life time,postoperative complications,subjective feeling of 3 month after surgical,score of Longo,score of Wexner,examination of defecography （P ＞0.05）.When the rectum anterior divergent degree more than 3.6 cm,STARR group in Longo and Wexner score is better than that of PPH group （P ＜0.05）,and the others were similar（P ＞0.05）.The STARR group was significantly longer than those of PPH group in operation time,hospitalization time （P ＜0.05）.Excision width of the STRAA group was greater than that of PPH group（P ＜0.05）.Subjective feeling in PPH group in postoperative one week was significantly better in group STRAA （P ＜0.05）.Conclusion PPH and STARR operation were good procedure for treatment of ODS.When the rectum anterior divergent degree is less than 3.6 cm,PPH has similar operation effect with STARR,however,it was shorter in hospitalization time,cheaper in the spend of hospitalization.As a result,PPH is a worthy popularizing operation to the treatment of a mild ODS.