University Hospital Giessen, Department of General, Visceral, Thoracic, Transplantation, and Pediatric Surgery, Giessen, Germany.
Dis Colon Rectum. 2011 Apr;54(4):412-7. doi: 10.1007/DCR.0b013e318205ddda.
Obstructed defecation syndrome is a multifactorial disorder of the defecation process. Stapled transanal rectal resection has been used to restore function in patients suffering from obstructed defecation syndrome.
The aim of this study was to use preoperative and postoperative dynamic pelvic floor MRI combined with clinical parameters to evaluate the outcome of stapled transanal rectal resection.
A prospective cohort study was conducted in a tertiary care center.
A group of 140 women with obstructed defecation syndrome were evaluated.
All 140 patients were initially treated conservatively with laxatives, increased fluid intake, pelvic floor exercises, and biofeedback. Stapled transanal rectal resection was performed in 30 patients with rectocele who did not show improvement in symptoms after at least 6 months of conservative treatment.
Preoperative diagnostic workup consisted of dynamic pelvic floor MRI, clinical examination, coloscopy, and clinical scores (Cleveland Clinic constipation score, German Working group on Coloproctology continence score, and SF-36 quality-of-life questionnaire). Postoperatively, patients were reevaluated at 3 months by means of dynamic pelvic floor MRI, clinical examination, and clinical scores; clinical scores were repeated at 6 months after the operation.
Postoperative dynamic pelvic floor MRI performed after a median of 3.4 months showed a decrease in rectocele size from 3.3 (interquartile range, 2.8-3.8) cm to 1.5 (1.2-2) cm (P < .001). The number of patients with intussusception decreased from 21 (70%) before the operation to none after the operation (P < .001). The size of cystoceles did not change. The number of patients with incomplete evacuation was significantly reduced (P < .001). With a mean follow-up of 18 ± 4 months, patients showed a significant improvement in the quality-of-life score (P < .001) but not in the continence scores.
Stapled transanal rectal resection is an effective treatment option for patients with obstructed defecation syndrome associated with rectocele and intussusception.
排便障碍综合征是一种多因素的排便过程障碍。吻合器经肛直肠切除术已被用于恢复排便障碍综合征患者的功能。
本研究旨在通过术前和术后动态盆底 MRI 结合临床参数来评估吻合器经肛直肠切除术的疗效。
这是一项在三级医疗中心进行的前瞻性队列研究。
140 例排便障碍综合征女性患者。
所有 140 例患者最初均接受保守治疗，包括泻药、增加液体摄入、盆底锻炼和生物反馈。对于至少经过 6 个月保守治疗症状仍未改善的直肠前突患者，行吻合器经肛直肠切除术。
术前诊断性检查包括动态盆底 MRI、临床检查、结肠镜检查和临床评分（克利夫兰诊所便秘评分、德国结直肠外科工作组控便评分和 SF-36 生活质量问卷）。术后 3 个月通过动态盆底 MRI、临床检查和临床评分进行再次评估；术后 6 个月重复临床评分。
术后中位时间 3.4 个月时行动态盆底 MRI 检查显示直肠前突体积从 3.3（四分位间距 2.83.8）cm 减小至 1.5（1.22）cm（P<0.001）。术前有 21 例（70%）存在套叠，术后均消失（P<0.001）。膀胱膨出体积无变化。不完全排空的患者数量明显减少（P<0.001）。平均随访 18±4 个月时，患者生活质量评分显著提高（P<0.001），但控便评分无变化。
吻合器经肛直肠切除术是治疗伴有直肠前突和套叠的排便障碍综合征的有效方法。
