Deng Qun, Yu Kai-Lin, Liu Zhi-Yong, Shen Zhong, Wang Ya-Hui, Song Yong-Mao, Wang Chang-Jian, Xu Xiao-Ping, Wang Jian-Wei
Department of Colorectal Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Department of Ultrasonography, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
Gastroenterol Rep (Oxf). 2020 Jul 4;8(6):457-464. doi: 10.1093/gastro/goaa027. eCollection 2020 Dec.
Obstructed defecation syndrome (ODS) is a condition that is frequently caused by rectocele and rectal intussusception. This study aimed to evaluate the effectiveness of a modified Bresler procedure for the treatment of ODS. The outcomes of this modified procedure were compared with the stapled transanal rectal resection (STARR) procedure.
We performed a retrospective analysis of the clinical data from 76 female patients who presented with ODS between June 2014 and June 2016. The patients were divided into two treatment groups, namely Modified and STARR. Patients in the Modified group (=36) underwent the modified Bresler procedure, which involved posterior rectal-wall resection using a circular tubular stapler with multilevel purse-string sutures. Patients in the STARR group (=40) underwent the standard STARR procedure. We analysed post-operative complications, Wexner constipation scores (WCS), rectocele depths, and four-point post-operative satisfaction scales.
Patients in the Modified group exhibited shorter operative times and fewer post-operative complications (both <0.05). At 12 months post-operatively, both the Modified and STARR groups displayed a significant improvement in the Wexner constipation score and the depth of rectocele. The post-operative WCS for the Modified group were significantly improved compared to those for the STARR group (<0.05), while there was no significant difference in the rectocele depth between the two groups (>0.05). Post-operative interviews at post-operative 12 months showed that patients in the Modified group had a better satisfaction (=0.05).
Our modified procedure may be an effective treatment strategy for patients experiencing ODS caused by rectocele and rectal intussusception, with fewer complications and effective relief of symptoms.
排便梗阻综合征（ODS）是一种常由直肠膨出和直肠套叠引起的病症。本研究旨在评估改良布雷斯勒手术治疗ODS的有效性。将该改良手术的结果与吻合器经肛门直肠切除术（STARR）进行比较。
我们对2014年6月至2016年6月期间出现ODS的76例女性患者的临床资料进行了回顾性分析。患者分为两个治疗组，即改良组和STARR组。改良组（n = 36）的患者接受改良布雷斯勒手术，该手术使用带多级荷包缝合的环形管状吻合器进行直肠后壁切除。STARR组（n = 40）的患者接受标准STARR手术。我们分析了术后并发症、韦克斯纳便秘评分（WCS）、直肠膨出深度和四点术后满意度量表。
改良组患者的手术时间较短，术后并发症较少（均P<0.05）。术后12个月，改良组和STARR组的韦克斯纳便秘评分和直肠膨出深度均有显著改善。改良组的术后WCS较STARR组有显著改善（P<0.05），而两组之间的直肠膨出深度无显著差异（P>0.05）。术后12个月的术后访谈显示，改良组患者的满意度更高（P = 0.05）。
我们的改良手术可能是治疗由直肠膨出和直肠套叠引起的ODS患者的有效治疗策略，并发症较少且能有效缓解症状。
