Liu Weicheng, Sturiale Alessandro, Fabiani Bernardina, Giani Iacopo, Menconi Claudia, Naldini Gabriele
1 Cisanello Hospital of Pisa, University Hospital of Pisa, Pisa, Italy.
Surg Innov. 2017 Dec;24(6):566-573. doi: 10.1177/1553350617723771. Epub 2017 Aug 4.
The aim of this study was to evaluate the medium-term outcomes of internal Delorme's procedure for treating obstructed defecation syndrome (ODS) patients with impaired anal continence.
In a retrospective study, 41 ODS patients who underwent internal Delorme's procedure between 2011 and 2015 were divided into 3 subgroups according to their associated symptoms of impaired continence, as urgency, passive fecal incontinence and both, before study. Then the patients' preoperative statuses, perioperative complications, and postoperative outcomes were investigated and collected from standardized questionnaires, including Altomare ODS score, Fecal Incontinence Severity Index (FISI), Patient Assessment of Constipation-Quality of Life Questionnaire (PAC-QoL), and Fecal Incontinence Quality of Life Scale (FIQLS). All results with a 2-tailed P < .05 were considered statistically significant.
At an average 2.8 years of follow-up, there were significant improvements ( P < .01) in Altomare ODS score, FISI, PAC-QoL, and FIQLS in all patients when comparing scores from before the operation with those at the final follow-up. Similar results were also observed in both the urgency subgroup and passive fecal incontinence subgroup, but there were no statistically significant improvements ( P > .05) in Altomare ODS score, FISI, PAC-QoL, or FIQLS in the urgency and passive fecal incontinence subgroups. Anorectal manometry showed the mean value of anal resting pressure increased 20%. Additionally, no major complications occurred.
Internal Delorme's procedure is effective without major morbidity for treating ODS associated with urgency or passive fecal incontinence, but it may be less effective for treating ODS associated with both urgency and passive fecal incontinence.
本研究旨在评估改良Delorme手术治疗肛门节制功能受损的排便障碍综合征（ODS）患者的中期疗效。
在一项回顾性研究中，将2011年至2015年间接受改良Delorme手术的41例ODS患者，根据术前存在的急迫性、被动性大便失禁及两者皆有的肛门节制功能受损相关症状分为3个亚组。然后通过标准化问卷调查并收集患者的术前状况、围手术期并发症及术后结果，问卷包括阿尔托马雷ODS评分、大便失禁严重程度指数（FISI）、便秘患者生活质量评估问卷（PAC-QoL）和大便失禁生活质量量表（FIQLS）。所有双侧P < 0.05的结果均被视为具有统计学意义。
平均随访2.8年时，将所有患者术前评分与末次随访时的评分相比，阿尔托马雷ODS评分、FISI、PAC-QoL和FIQLS均有显著改善（P < 0.01）。在急迫性亚组和被动性大便失禁亚组中也观察到类似结果，但在急迫性和被动性大便失禁亚组中，阿尔托马雷ODS评分、FISI、PAC-QoL或FIQLS均无统计学意义上的显著改善（P > 0.05）。肛门直肠测压显示肛门静息压平均值升高了20%。此外，未发生重大并发症。
改良Delorme手术治疗伴有急迫性或被动性大便失禁的ODS有效且无重大并发症，但对于治疗同时伴有急迫性和被动性大便失禁的ODS可能效果较差。
