Division of Minimally Invasive Colon and Rectal Surgery, Department of Surgery, University of Texas Medical School at Houston, Houston, Texas 77054, USA.
J Surg Res. 2011 Jan;165(1):e15-21. doi: 10.1016/j.jss.2010.07.045. Epub 2010 Aug 18.
Obstructed defecation syndrome (ODS) is recognized as a functional (e.g., anismus) and anatomic (e.g., rectocele and rectal intussusception) defecatory disorder of the pelvic floor. This study was designed to evaluate outcomes and patient satisfaction following stapled transanal rectal resection (STARR) for the surgical treatment of ODS.
Between May 2006 and July 2009, 37 patients underwent STARR for correction of ODS secondary to rectocele and internal intussusception. Demographic data and postoperative outcomes were tabulated. Symptomatic outcomes were assessed by comparing pre- and postoperative subsets of the Wexner constipation scoring system, and quality outcomes were evaluated with patient satisfaction surveys.
Thirty-seven female patients with a mean age of 52.9 ± 11.2 y underwent STARR. All patients had clinically significant rectocele as evidenced on defecography and 81.1% had concomitant internal rectal intussusception. Postoperative complications occurred in 13 patients (35.1%). Two of these patients required re-intervention: dilation of stricture and transanal excision of staple granuloma. Mean quality of life follow-up occurred at 20.3 ± 6.5 mo (median: 20 mo, range: 9-36 mo). Mean preoperative and postoperative constipation subset scores were 11.1 ± 3.6 and 4.6 ± 3.9, respectively (P < 0.00001). Overall outcome was reported as "excellent" or "good" in 71.9% of patients, "adequate" in 15.6%, and "poor" in 12.5%. When asked if they would undergo the procedure again, 81.3% responded affirmatively.
The STARR procedure results in improved symptomatic outcomes, high patient satisfaction, and an acceptable complication rate. In selected patients, this minimally invasive approach was an acceptable procedure for the surgical correction of ODS secondary to rectocele and intussusception.
阻塞性排便综合征（ODS）被认为是一种盆底功能（例如，肛门失弛缓症）和解剖（例如，直肠前突和直肠内套叠）排便障碍。本研究旨在评估经吻合器经肛直肠切除术（STARR）治疗 ODS 的手术治疗结果和患者满意度。
2006 年 5 月至 2009 年 7 月，37 例患者因直肠前突和内套叠导致 ODS 接受 STARR 治疗。记录人口统计学数据和术后结果。通过比较术前和术后 Wexner 便秘评分系统的亚组来评估症状结果，通过患者满意度调查来评估生活质量结果。
37 例平均年龄 52.9 ± 11.2 岁的女性患者接受 STARR 治疗。所有患者均有明显的直肠前突，经排粪造影证实，81.1%的患者同时伴有直肠内套叠。13 例患者（35.1%）发生术后并发症。其中 2 例患者需要再次干预：扩张狭窄和经肛门切除吻合钉肉芽肿。平均生活质量随访时间为 20.3 ± 6.5 个月（中位数：20 个月，范围：9-36 个月）。术前和术后便秘亚组评分分别为 11.1 ± 3.6 和 4.6 ± 3.9（P < 0.00001）。71.9%的患者报告总体结局为“优秀”或“良好”，15.6%为“尚可”，12.5%为“较差”。当被问及是否会再次接受该手术时，81.3%的患者给予肯定答复。
STARR 手术可改善症状结果，提高患者满意度，且并发症发生率可接受。在选择合适的患者中，这种微创方法是治疗直肠前突和内套叠导致 ODS 的一种可接受的手术方法。
