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。

Complications after stapled transanal rectal resection for obstructed defecation

Objective To evaluate the safety of stapled transanal rectal resection(STARR)for the treatment of obstructed defecation syndrome (ODS).Methods A retrospective study was performed in 112 female patients with ODS eligible for STARR.The short-lerm and long-term postoperative complications were recorded and assessed.Results Short-term postoperative complications and adverse events were reported in 18 patients(16.1％) including fecal incontinence(4.5％),anastomotic bleeding (2.7％),staple line partial dehiscence (0.9％),anal fissure (2.7％),acute urinary retention( 1.8％ ),thrombosed external hemorrhoid( 1.8％ ),hematoma of the rectovaginal septum (0.9％)and fecal impaction (0.9％).Reoperation was required in 2 patients (1.8％) due to the short-term postoperative complications.The median length of follow-up was 24 months.There were 6 patients with long-term postoperative complications (5.4％) including fecal incontinence (1.8％),defecatory urgency (0.9％),chronic pain due to anastomotic inflammation (1.8％),and chronic pain due to anal rectal diverticulum(0.9％).Three patients(2.7％) were reoperated.Conclusion STARR appears to be a safe technique for patients with obstructed defecation.