目的 评估经肛吻合器直肠切除术治疗出口梗阻型便秘的疗效及安全性.方法 2007年1月至2008年8月对56例经排粪造影证实存在直肠前突和(或)直肠套叠脱乖的出口梗阻型便秘患者,行吻合器经肛直肠切除手术,比较术前和术后临床症状缓解情况,并量化评分比较.结果 手术时间平均28 min,术后3 d内VAS疼痛评分平均3.2分.2例患者术后随访6个月,有轻度肛门失禁;2例患者分别随访2、4个月,吻合口有轻度炎症,致排便时肛门部轻度疼痛.无其他并发症发生.术后平均随访8个月,各项出几梗阻症状发牛率较术前均显著下降,尤其是排便困难及排便梗阻感的发生率均下降50%以上,差异均有统计学意义(P<0.05).量化评分后比较,术后便不尽感积分较术前下降65%,其余症状积分下降幅度均达72%以上,差异均有统计学意义(P<0.05).结论 经肛吻合器直肠切除术治疗出口梗阻型便秘操作简单、创伤小、痛苦少、并发症少,近期疗效较满意.%Objective To evaluate the effectiveness and safety of stapled transanal rectum resection (STARR) in the treatment of obstructed defecation syndrome(ODS). Methods Fifty-six patients with ODS who had rectocele and／or intussusception were treated with STARR from January 2007 to August 2008. The incidence of preoperative and postoperative symptoms of ODS was compared. Symptomatic relief was also observed by using scoring system. Results The average operation time was 28 min, and in the first 3 days after operation the average VAS pain score was 3. 2 points．Two patients experienced mild anal incontinence when followed-up to 6 months; 2 patients suffered mild anal pain during defecation due to slight anastomotic inflammation 2 and 4 months after the operation, respectively. No other complications was found． The mean follow-up period was 8 months after surgery, and the rate of symptoms of ODS reduced significantly compared with that before surgery, in particular the incidence of the difficult and obstructive defecation feelings decreased for more than 50 percents (P < 0. 05). Compared with that before the operation, the sense of no emptying stool decreased for 65 percents and all the other symptoms reduced for more than 72 percents (all P < 0. 05). Conclusion The stapled transanal rectum resection is simple, less invasive, less painful and with fewer complications and more satisfactory recent effect in treating obstructed defecation syndrome.
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