Department of Colorectal Surgery, Colorectal Disease Center of PLA, The Second Artillary General Hospital, Beijing, People's Republic of China.
Dis Colon Rectum. 2011 Apr;54(4):418-24. doi: 10.1007/DCR.0b013e3182061c81.
Stapled transanal rectal resection is a novel surgery for obstructed defecation syndrome. Few data on the functional and morphologic outcome after the surgery have been reported.
This study aimed to evaluate the functional and morphologic outcome after stapled transanal rectal resection.
This is a prospective study of consecutive patients undergoing transanal rectal resection.
The study was conducted at a tertiary referral hospital, Beijing, China, from May 2007 to May 2009.
Eighty-six consecutive female patients with obstructed defecation syndrome were carefully selected.
All patients underwent stapled transanal rectal resection.
The main outcome measures were patients' symptoms, obstructed defecation syndrome score, Wexner incontinence score, anorectal manometry and defecography before and 1 year after surgery.
The occurrence of all symptoms were significantly reduced after the procedure (P < .0001). Obstructed defecation syndrome score was decreased from 18.17 ± 4.68 preoperatively to 7.36 ± 3.52 postoperatively (P < .0001) with the Wexner incontinence score unchanged. Maximum tolerable rectal volume was significantly decreased (236.08 ± 50.00 vs 205.25 ± 29.60, P < .0001) after surgery with anal sphincter pressures unchanged. Postoperative defecography was performed in 64 patients. Rectocele disappeared in 40 of 62 patients. The depth of rectocele was reduced from 35.40 ± 4.58 mm preoperatively to 19.77 ± 9.19 mm postoperatively (P < .0001). Incomplete evacuation disappeared in 41 of 51 patients. Intussusception was completely corrected in 39 of 56 patients. The reduction of obstructed defection syndrome score was greater in patients with both rectocele and intussusception corrected than others (12.75 ± 2.24 vs 9.17 ± 3.47; P < .0001).
This study was limited owing to the lack of a control group and the medium-term results.
Stapled transanal rectal resection is an effective procedure for obstructed defecation syndrome. The functional outcome is good with the preservation of sphincter function and continence postoperatively. The morphologic outcome confirmed its efficacy in correcting rectocele and intussusception, and correlated well with clinical improvement.
经肛吻合器直肠切除术是一种治疗出口梗阻型便秘的新型手术。目前报道的关于该手术术后功能和形态学结果的数据很少。
本研究旨在评估经肛吻合器直肠切除术的术后功能和形态学结果。
这是一项对接受经肛直肠切除术的连续患者进行的前瞻性研究。
本研究在北京一家三级转诊医院进行，时间为 2007 年 5 月至 2009 年 5 月。
86 例经仔细选择的女性出口梗阻型便秘患者。
所有患者均接受经肛吻合器直肠切除术。
手术前后患者的症状、便秘症状评分、Wexner 失禁评分、直肠肛管测压和排粪造影。
术后所有症状均明显减少（P<.0001）。便秘症状评分从术前的 18.17±4.68 降至术后的 7.36±3.52（P<.0001），Wexner 失禁评分无变化。最大耐受直肠容量显著减少（236.08±50.00 比 205.25±29.60，P<.0001），而肛门括约肌压力无变化。64 例患者术后行排粪造影，62 例直肠前突患者中 40 例消失。直肠前突深度从术前的 35.40±4.58mm 降至术后的 19.77±9.19mm（P<.0001）。51 例不完全排空患者中 41 例消失。56 例内套叠患者中 39 例完全纠正。直肠前突和内套叠均得到纠正的患者的便秘症状评分降低更明显（12.75±2.24 比 9.17±3.47；P<.0001）。
本研究由于缺乏对照组和中期结果而受到限制。
经肛吻合器直肠切除术是一种治疗出口梗阻型便秘的有效方法。术后保留了肛门括约肌功能和控便功能，功能结果良好。形态学结果证实了其纠正直肠前突和内套叠的疗效，并与临床改善密切相关。
