• 1.中國人民解放軍第二炮兵總醫(yī)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(yī)院婦產(chǎn)科(北京 100088);

目的  經(jīng)肛吻合器直腸切除術(shù)（STARR）與橋式縫合術(shù)分別是經(jīng)肛門、經(jīng)陰道治療直腸前突較新的術(shù)式，本研究擬對這兩種術(shù)式進(jìn)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(shù)的住院患者的臨床資料，根據(jù)不同手術(shù)途徑分為STARR組(n=18)和橋式縫合組(n=13)，對2組患者手術(shù)后癥狀改善情況、手術(shù)時間、出血量、住院時間、費(fèi)用、并發(fā)癥等進(jìn)行比較。
結(jié)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(shù)時間為24.6 min，平均出血量為3.9 ml，平均住院費(fèi)用為10 743元； 橋式縫合組平均手術(shù)時間為33.2 min，平均出血量為16.2 ml，平均住院費(fèi)用為3 543元，STARR組的這3項指標(biāo)小于（多于）橋式縫合組（P lt;0.01）。 2組住院時間相近，STARR組術(shù)后有2例出現(xiàn)輕度肛門失禁，3個月后自然恢復(fù)。
結(jié)論  STARR對改善排便困難療效優(yōu)于陰道后壁橋式縫合術(shù)，但也有缺點(diǎn)，如費(fèi)用高，術(shù)后短期內(nèi)有的患者發(fā)生輕度肛門失禁，但能夠自行恢復(fù)。

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

1. 朱蘭， 郎景和， 丁小曼， 等. 陰道后壁“橋”式縫合術(shù)的應(yīng)用 [J]. 中華婦產(chǎn)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(jīng)肛直腸切除術(shù)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(shù)治療 [J]. 中國實(shí)用婦科與產(chǎn)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(bǔ)術(shù)53例臨床分析 [J]. 實(shí)用婦產(chǎn)科雜志， 2008； 24（4）： 241243.
  1. 1. 朱蘭， 郎景和， 丁小曼， 等. 陰道后壁“橋”式縫合術(shù)的應(yīng)用 [J]. 中華婦產(chǎn)科雜志， 2005； 40（12）： 859860.
  2. 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. 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. 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. 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. 6. Ellis CN. Stapled transanal rectal resection (STARR) for rectocele [J]. J Gastrointest Surg, 2007; 11(2): 153154.
  7. 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. 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. 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. 10. 丁健華， 趙克， 朱軍, 等. 吻合器經(jīng)肛直腸切除術(shù)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. 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. 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. 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. 14. 朱蘭， 王巍. 后盆腔缺陷疾病的手術(shù)治療 [J]. 中國實(shí)用婦科與產(chǎn)科雜志， 2006; 22（4）： 318320.
  15. 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. 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. 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. 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. 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. 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. 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. 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. 23. 孫智晶， 朱蘭， 郎景和. 陰道后壁“橋”式修補(bǔ)術(shù)53例臨床分析 [J]. 實(shí)用婦產(chǎn)科雜志， 2008； 24（4）： 241243.