Department of General, Visceral, Vascular and Paediatric Surgery, University Hospital Wuerzburg, Wuerzburg, Germany.
Dis Colon Rectum. 2011 May;54(5):593-600. doi: 10.1007/DCR.0b013e318207ecad.
Stapled transanal rectum resection is becoming increasingly popular as a surgical option for the treatment of obstructive defecation syndrome. However, details about the anatomical changes produced by stapled transanal rectum resection and its correlation with success or failure is poorly understood. The aim of this study was to correlate the defecographical and clinical patterns in patients treated with stapled transanal rectum resection.
Based on a multi-institutional stapled transanal rectum resection registry composed of a total of 182 patients, correlation analysis of clinical and radiological parameters was prospectively obtained from 51 patients with a completed 12-month follow-up.
Postoperative defecography shows significant changes in the following parameters: intussusception (89%-19%; P < .0001), enterocele (38%-18%; P = .038), rectocele (mean ± SD: 27.1 ± 7.4 mm to 16.5 ± 9.7 mm; P < .0001), rectal lumen (mean ± SD: 46 ± 11.4 mm to 35 ± 9.9 mm; P < .0001), anorectal angle (mean ± SD: 146.4 ± 10.6° to 132.4 ± 11.1°; P = .002), pelvic floor descent (mean ± SD: 59 ± 18 mm to 47 ± 1.3 mm; P = .0001), and, as a dynamic parameter, dynamic pelvic floor descent (mean ± SD: 30 ± 0.8 mm to 17 ± 0.4 mm; P < .0001). Of these parameters, reduction of intussusception (r = 0.433, 95% CI 0.15-0.61; P = .003), rectocele (r = 0.507, 95% CI 0.26-0.67; P = .001), and dynamic pelvic floor descent (r = 0.427, 95% CI 0.31-0.64; P = .001) correlated with a significant improvement in constipation. Reduction of intussusception positively affected postoperative continence (r = 0.524, 95% CI 0.29-0.70; P = .001), whereas reduced rectal lumen size correlated with incontinence and fecal urgency (r = -0.557, 95% CI -0.69 to -0.28; P = .001).
Improved constipation after stapled transanal rectum resection is associated with improvement of intussusception, rectocele, and dynamic pelvic floor descent. Postoperative continence is determined by 2 parameters, reduction of intussusception and rectal lumen size, which have opposing effects. Reduction of rectal lumen size may be responsible for new-onset fecal urgency, which is occasionally seen after stapled transanal rectum resection.
经肛吻合器直肠切除术作为一种治疗梗阻性排便综合征的手术方法，越来越受到关注。然而，经肛吻合器直肠切除术所引起的解剖学变化及其与手术成败的关系尚不清楚。本研究旨在分析经肛吻合器直肠切除术患者的排粪造影和临床特征。
基于一个由 182 例患者组成的多机构经肛吻合器直肠切除术登记处，前瞻性地从完成 12 个月随访的 51 例患者中获得临床和影像学参数的相关性分析。
术后排粪造影显示以下参数发生显著变化：套叠（89%-19%；P<0.0001）、会阴疝（38%-18%；P=0.038）、直肠前突（平均±标准差：27.1±7.4mm 至 16.5±9.7mm；P<0.0001）、直肠腔（平均±标准差：46±11.4mm 至 35±9.9mm；P<0.0001）、肛直角（平均±标准差：146.4±10.6°至 132.4±11.1°；P=0.002）、盆底下降（平均±标准差：59±18mm 至 47±1.3mm；P=0.0001）和动态盆底下降（平均±标准差：30±0.8mm 至 17±0.4mm；P<0.0001）。这些参数中，套叠（r=0.433，95%置信区间 0.15-0.61；P=0.003）、直肠前突（r=0.507，95%置信区间 0.26-0.67；P=0.001）和动态盆底下降（r=0.427，95%置信区间 0.31-0.64；P=0.001）的减少与便秘的显著改善相关。套叠的减少对术后控便能力有积极影响（r=0.524，95%置信区间 0.29-0.70；P=0.001），而直肠腔缩小与失禁和粪便急迫有关（r=-0.557，95%置信区间-0.69 至-0.28；P=0.001）。
经肛吻合器直肠切除术改善便秘与套叠、直肠前突和动态盆底下降的改善有关。术后控便能力由 2 个参数决定，套叠和直肠腔缩小，这两个参数具有相反的作用。直肠腔缩小可能是新出现的粪便急迫的原因，这在经肛吻合器直肠切除术后偶尔会发生。
