吻合器經肛直腸切除術與經陰道手術治療直腸前突的比較_《中國普外基礎與臨床雜志》

作者：

尹淑慧 ¹ , 趙克 ¹ , 侯慶香 ² , 丁健華 ¹

1.中國人民解放軍第二炮兵總醫院肛腸外科，全軍肛腸病專病中心(北京 100088);;
2.中國人民解放軍第二炮兵總醫院婦產科(北京 100088);

關鍵詞：

吻合器經肛直腸切除術陰道后壁橋式縫合術直腸前突出口梗阻性便秘

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目的經肛吻合器直腸切除術（STARR）與橋式縫合術分別是經肛門、經陰道治療直腸前突較新的術式，本研究擬對這兩種術式進行比較。
方法回顧性分析2007年1月至2009年5月期間因直腸前突排便困難接受手術的住院患者的臨床資料，根據不同手術途徑分為STARR組(n=18)和橋式縫合組(n=13)，對2組患者手術后癥狀改善情況、手術時間、出血量、住院時間、費用、并發癥等進行比較。
結果 STARR組排便困難顯著改善11例，明顯改善5例，橋式縫合組顯著改善4例，明顯改善2例，STARR組總改善率（88.9%）高于橋式縫合組（46.2%），P=0.017。 STARR組平均手術時間為24.6 min，平均出血量為3.9 ml，平均住院費用為10 743元；橋式縫合組平均手術時間為33.2 min，平均出血量為16.2 ml，平均住院費用為3 543元，STARR組的這3項指標小于（多于）橋式縫合組（P lt;0.01）。 2組住院時間相近，STARR組術后有2例出現輕度肛門失禁，3個月后自然恢復。
結論 STARR對改善排便困難療效優于陰道后壁橋式縫合術，但也有缺點，如費用高，術后短期內有的患者發生輕度肛門失禁，但能夠自行恢復。

引用本文： 尹淑慧,趙克,侯慶香,丁健華. 吻合器經肛直腸切除術與經陰道手術治療直腸前突的比較. 中國普外基礎與臨床雜志, 2010, 17(2): 129-132. doi: 復制

1.	朱蘭，郎景和，丁小曼，等. 陰道后壁“橋”式縫合術的應用 [J]. 中華婦產科雜志， 2005； 40（12）： 859860.
2.	Longo A. Obstructed defecation because of rectal pathologies. Novel surgical treatment: stapled transanal resection(STARR). Annual Cleveland Clinic Florida Colorectal Disease Symposium. January 2005; Ft. Lauderdale, FL.
3.	Boccasanta P, Venturi M, Salamina G, et al. New trends in the surgical treatment of outlet obstruction: clinical and functional results of two novel transanal stapled techniques from a randomised controlled trial [J]. Int J Colorectal Dis, 2004; 19(4): 359369.
4.	Corman ML, Carriero A, Hager T, et al. Consensus conference on the stapled transanal rectal resection (STARR) for disordered defaecation [J]. Colorectal Dis, 2006; 8(2): 98101.
5.	Ommer A, Albrecht K, Wenger F, et al. Stapled transanal rectal resection (STARR): a new option in the treatment of obstructive defecation syndrome [J]. Langenbecks Arch Surg, 2006; 391(1): 3237.
6.	Ellis CN. Stapled transanal rectal resection (STARR) for rectocele [J]. J Gastrointest Surg, 2007; 11(2): 153154.
7.	Schwandner O, Stuto A, Jayne D, et al. Decisionmaking algorithm for the STARR procedure in obstructed defecation syndrome: position statement of the group of STARR pioneers [J]. Surg Innov, 2008; 15(2): 105109.
8.	Guarnieri A, Cesaretti M, Tirone, A, et al. Stapled transanal rectal resection (STARR) in the treatment of rectocele: personal experience [J]. Chir Ital, 2008; 60(2): 243248.
9.	Lehur PA, Stuto A, Fantoli M, et al. Outcomes of stapled transanal rectal resection vs. biofeedback for the treatment of outlet obstruction associated with rectal intussusception and rectocele: a multicenter, randomized, controlled trial [J]. Dis Colon Rectum, 2008; 51(11): 16111618.
10.	丁健華，趙克，朱軍, 等. 吻合器經肛直腸切除術治療出口梗阻型便秘療效分析 [J]. 中華普通外科雜志， 2009： 24（3）： 249250.
11.	Farouk R, Bhardwaj R, Phillips RK. Stapled transanal resection of the rectum (STARR) for the obstructed defaecation syndrome [J]. Ann R Coll Surg Engl, 2009; 91(4): 287291.
12.	Altomare DF, Spazzafumo L, Rinaldi M, et al. Setup and statistical validation of a new scoring system for obstructed defaecation syndrome [J]. Colorectal Dis， 2008; 10（1）： 8488.
13.	Grassi R, Romano S, Micera O, et al. Radiographic findings of postoperative double stapled trans anal rectal resection (STARR) in patient with obstructed defecation syndrome (ODS) [J]. Eur J Radiol, 2005; 53(3): 410416.
14.	朱蘭，王巍. 后盆腔缺陷疾病的手術治療 [J]. 中國實用婦科與產科雜志， 2006; 22（4）： 318320.
15.	Renzi A, Talento P, Giardiello C, et al. stapled transanal rectal resection (STARR) by a new dedicated device for the surgical treatment of obstructed defaecation syndrome caused by rectal intussusception and rectocele: early results of a multicenter prospective study [J]. Int J Colorectal Dis, 2008; 23(10): 9991005.
16.	Jayne DG, Schwandner O, Stuto A. Stapled transanal rectal resection for obstructed defecation syndrome: oneyear results of the European STARR Registry [J]. Dis Colon Rectum, 2009; 52(7): 12051212.
17.	Slim K, Mezoughi S, LaunaySavary MV, et al. Repair of rectocele using the Stapled TransAnal Rectal Resection (STARR) technique: intermediate results from a multicenter French study [J]. J Chir (Paris), 2008; 145(1): 2731.
18.	Frascio M, Stabilini C, Ricci B, et al. Stapled transanal rectal resection for outlet obstruction syndrome: results and followup [J]. World J Surg, 2008; 32(6): 11101115.
19.	Arroyo A, GonzalezArgente FX, GarciaDomingo M, et al. Prospective multicentre clinical trial of stapled transanal rectal resection for obstructive defaecation syndrome [J]. Br J Surg, 2008; 95(12): 15211527.
20.	Boccasanta P, Venturi M, Stuto A, et al. Stapled transanal rectal resection for outlet obstruction: a prospective, multicenter trial [J]. Dis Colon Rectum, 2004; 47(8): 12851296.
21.	Gagliardi G, Pescatori M, Altomare DF, et al. Results, outcome predictors, and complications after stapled transanal rectal resection for obstructed defecation [J]. Dis Colon Rectum, 2008； 51(2): 186195.
22.	Harris MA, Ferrara A, Gallagher J, et al. Stapled transanal rectal resection vs. transvaginal rectocele repair for treatment of obstructive defecation syndrome [J]. Dis Colon Rectum, 2009; 52(4): 592597.
23.	孫智晶，朱蘭，郎景和. 陰道后壁“橋”式修補術53例臨床分析 [J]. 實用婦產科雜志， 2008； 24（4）： 241243.

1. 朱蘭，郎景和，丁小曼，等. 陰道后壁“橋”式縫合術的應用 [J]. 中華婦產科雜志， 2005； 40（12）： 859860.
2. Longo A. Obstructed defecation because of rectal pathologies. Novel surgical treatment: stapled transanal resection(STARR). Annual Cleveland Clinic Florida Colorectal Disease Symposium. January 2005; Ft. Lauderdale, FL.
3. Boccasanta P, Venturi M, Salamina G, et al. New trends in the surgical treatment of outlet obstruction: clinical and functional results of two novel transanal stapled techniques from a randomised controlled trial [J]. Int J Colorectal Dis, 2004; 19(4): 359369.
4. Corman ML, Carriero A, Hager T, et al. Consensus conference on the stapled transanal rectal resection (STARR) for disordered defaecation [J]. Colorectal Dis, 2006; 8(2): 98101.
5. Ommer A, Albrecht K, Wenger F, et al. Stapled transanal rectal resection (STARR): a new option in the treatment of obstructive defecation syndrome [J]. Langenbecks Arch Surg, 2006; 391(1): 3237.
6. Ellis CN. Stapled transanal rectal resection (STARR) for rectocele [J]. J Gastrointest Surg, 2007; 11(2): 153154.
7. Schwandner O, Stuto A, Jayne D, et al. Decisionmaking algorithm for the STARR procedure in obstructed defecation syndrome: position statement of the group of STARR pioneers [J]. Surg Innov, 2008; 15(2): 105109.
8. Guarnieri A, Cesaretti M, Tirone, A, et al. Stapled transanal rectal resection (STARR) in the treatment of rectocele: personal experience [J]. Chir Ital, 2008; 60(2): 243248.
9. Lehur PA, Stuto A, Fantoli M, et al. Outcomes of stapled transanal rectal resection vs. biofeedback for the treatment of outlet obstruction associated with rectal intussusception and rectocele: a multicenter, randomized, controlled trial [J]. Dis Colon Rectum, 2008; 51(11): 16111618.
10. 丁健華，趙克，朱軍, 等. 吻合器經肛直腸切除術治療出口梗阻型便秘療效分析 [J]. 中華普通外科雜志， 2009： 24（3）： 249250.
11. Farouk R, Bhardwaj R, Phillips RK. Stapled transanal resection of the rectum (STARR) for the obstructed defaecation syndrome [J]. Ann R Coll Surg Engl, 2009; 91(4): 287291.
12. Altomare DF, Spazzafumo L, Rinaldi M, et al. Setup and statistical validation of a new scoring system for obstructed defaecation syndrome [J]. Colorectal Dis， 2008; 10（1）： 8488.
13. Grassi R, Romano S, Micera O, et al. Radiographic findings of postoperative double stapled trans anal rectal resection (STARR) in patient with obstructed defecation syndrome (ODS) [J]. Eur J Radiol, 2005; 53(3): 410416.
14. 朱蘭，王巍. 后盆腔缺陷疾病的手術治療 [J]. 中國實用婦科與產科雜志， 2006; 22（4）： 318320.
15. Renzi A, Talento P, Giardiello C, et al. stapled transanal rectal resection (STARR) by a new dedicated device for the surgical treatment of obstructed defaecation syndrome caused by rectal intussusception and rectocele: early results of a multicenter prospective study [J]. Int J Colorectal Dis, 2008; 23(10): 9991005.
16. Jayne DG, Schwandner O, Stuto A. Stapled transanal rectal resection for obstructed defecation syndrome: oneyear results of the European STARR Registry [J]. Dis Colon Rectum, 2009; 52(7): 12051212.
17. Slim K, Mezoughi S, LaunaySavary MV, et al. Repair of rectocele using the Stapled TransAnal Rectal Resection (STARR) technique: intermediate results from a multicenter French study [J]. J Chir (Paris), 2008; 145(1): 2731.
18. Frascio M, Stabilini C, Ricci B, et al. Stapled transanal rectal resection for outlet obstruction syndrome: results and followup [J]. World J Surg, 2008; 32(6): 11101115.
19. Arroyo A, GonzalezArgente FX, GarciaDomingo M, et al. Prospective multicentre clinical trial of stapled transanal rectal resection for obstructive defaecation syndrome [J]. Br J Surg, 2008; 95(12): 15211527.
20. Boccasanta P, Venturi M, Stuto A, et al. Stapled transanal rectal resection for outlet obstruction: a prospective, multicenter trial [J]. Dis Colon Rectum, 2004; 47(8): 12851296.
21. Gagliardi G, Pescatori M, Altomare DF, et al. Results, outcome predictors, and complications after stapled transanal rectal resection for obstructed defecation [J]. Dis Colon Rectum, 2008； 51(2): 186195.
22. Harris MA, Ferrara A, Gallagher J, et al. Stapled transanal rectal resection vs. transvaginal rectocele repair for treatment of obstructive defecation syndrome [J]. Dis Colon Rectum, 2009; 52(4): 592597.
23. 孫智晶，朱蘭，郎景和. 陰道后壁“橋”式修補術53例臨床分析 [J]. 實用婦產科雜志， 2008； 24（4）： 241243.

《中國普外基礎與臨床雜志》

吻合器經肛直腸切除術與經陰道手術治療直腸前突的比較

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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《中國普外基礎與臨床雜志》

吻合器經肛直腸切除術與經陰道手術治療直腸前突的比較

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

摘要全文圖表視頻參考文獻施引文獻補充材料