Bin Zhang, Jian-Hua Ding, Yu-Juan Zhao, Shu-Hui Yin, Ying-Ying Feng, Ke Zhao, Department of Colorectal Surgery, the Second Artillery General Hospital, Beijing 100088, China.
World J Gastroenterol. 2013 Oct 14;19(38):6472-8. doi: 10.3748/wjg.v19.i38.6472.
To assess midterm results of stapled transanal rectal resection (STARR) for obstructed defecation syndrome (ODS) and predictive factors for outcome.
From May 2007 to May 2009, 75 female patients underwent STARR and were included in the present study. Preoperative and postoperative workup consisted of standardized interview and physical examination including proctoscopy, colonoscopy, anorectal manometry, and defecography. Clinical and functional results were assessed by standardized questionnaires for the assessment of constipation constipation scoring system (CSS), Longo's ODS score, and symptom severity score (SSS), incontinence Wexner incontinence score (WS), quality of life Patient Assessment of Constipation-Quality of Life Questionnaire (PAC-QOL), and patient satisfaction visual analog scale (VAS). Data were collected prospectively at baseline, 12 and 30 mo.
The median follow-up was 30 mo (range, 30-46 mo). Late postoperative complications occurred in 11 (14.7%) patients. Three of these patients required procedure-related reintervention (one diverticulectomy and two excision of staple granuloma). Although the recurrence rate was 10.7%, constipation scores (CSS, ODS score and SSS) significantly improved after STARR (P < 0.0001). Significant reduction in ODS symptoms was matched by an improvement in the PAC-QOL and VAS (P < 0.0001), and the satisfaction index was excellent in 25 (33.3%) patients, good in 23 (30.7%), fairly good in 14 (18.7%), and poor in 13 (17.3%). Nevertheless, the WS increased after STARR (P = 0.0169). Incontinence was present or deteriorated in 8 (10.7%) patients; 6 (8%) of whom were new onsets. Univariate analysis revealed that the occurrence of fecal incontinence (preoperative, postoperative or new-onset incontinence; P = 0.028, 0.000, and 0.007, respectively) was associated with the success of the operation.
STARR is an acceptable procedure for the surgical correction of ODS. However, its impact on symptomatic recurrence and postoperative incontinence may be problematic.
评估经肛吻合器直肠切除术（STARR）治疗出口梗阻型便秘（ODS）的中期疗效及影响疗效的预测因素。
2007 年 5 月至 2009 年 5 月，75 例女性患者接受 STARR 治疗，纳入本研究。术前和术后评估包括标准化的访谈和体格检查，包括直肠镜、结肠镜、肛肠测压和排粪造影。采用便秘评分系统（CSS）、Longo ODS 评分、症状严重程度评分（SSS）、失禁 Wexner 失禁评分（WS）、生活质量患者便秘生活质量问卷（PAC-QOL）和患者满意度视觉模拟评分（VAS）对临床和功能结果进行评估。数据在基线、12 个月和 30 个月时进行前瞻性收集。
中位随访时间为 30 个月（范围 30-46 个月）。11 例（14.7%）患者发生晚期术后并发症。其中 3 例需要与手术相关的再次干预（1 例憩室切除术和 2 例吻合钉肉芽肿切除术）。尽管复发率为 10.7%，但 STARR 后便秘评分（CSS、ODS 评分和 SSS）显著改善（P<0.0001）。ODS 症状的显著改善与 PAC-QOL 和 VAS 的改善相匹配（P<0.0001），25 例（33.3%）患者满意度指数为优，23 例（30.7%）为良，14 例（18.7%）为可，13 例（17.3%）为差。然而，WS 在 STARR 后增加（P=0.0169）。术后出现或加重失禁 8 例（10.7%）；其中 6 例（8%）为新发。单因素分析显示，粪便失禁的发生（术前、术后或新发失禁；P=0.028、0.000 和 0.007）与手术的成功有关。
STARR 是治疗 ODS 的一种可接受的手术方法。然而，其对症状复发和术后失禁的影响可能是一个问题。
