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.

Comparison of stapled transanal rectal resection versus Block repair in the treatment of retocele

Objective To compare the therapeutic efficacies of stapled transanal rectal resection （STARR） versus Block repair in the treatment of rectocele. Methods This retrospective study exam- ined the data of 67 patients undergoing surgery for rectocele from January 2008 to January 2012. They were divided into STARR group （n = 36） and Block group （n = 31 ） according to different operative procedures. Their symptoms were graded according to Longo＇s obstructed defecation syndrome （ODS） grading system. The scores were compared between two groups, including operative duration, intrao- perative bleeding volume, postoperative complications, hospitalization time and hospitalization expen- ses. Results The postoperative symptoms of constipation significantly improved for both groups. Comparing the Longo＇s ODS scores at 1 month with 3 and 12 months post-operation, no significant difference existed in the STARR group （P〉0. 05） while there was significant difference in the Block group （P〈0. 05）. The operative duration, intraoperative bleeding volume, operative complications or hospitalization time had no significant inter-group differences （P 〉 0. 05 ）. The expenses of the STARR group were much higher than those of the Block group （P〈0. 05）. Conclusions As com- pared with Block, STARR has better long-term outcomes with higher expenses.