改良STARR术联合围手术期生物反馈治疗排粪障碍综合征

发布时间：2018-08-15 18:35

【摘要】：目的:探讨改良经肛吻合器直肠部分切除术(Improved STARR)联合围手术期盆底生物反馈治疗排粪障碍综合征(ODS)的临床疗效及安全性。方法:回顾性分析2014年10月到2016年1月吉林大学第一医院结直肠肛门外科行改良STARR手术联合围手术期生物反馈治疗的30例女性排粪障碍综合征患者的相应临床资料。全组患者均在进行1个疗程盆底生物反馈治疗(治疗时间20 min/次、2次/d、10次为1个疗程)后行改良STARR手术,出院后于门诊继续行2个疗程的盆底生物反馈治疗。疗效评估指标包括患者一般情况及术后并发症情况、治疗前后患者的主观感受分级(极好:无任何不适症状;好:每月应用1~2次缓泻剂且不需手指或灌肠等辅助排便;良:每月3次及以上应用缓泻剂;差:症状没有改善)、Longo ODS评分(分值范围为0~40分,分值越高,症状越严重)、胃肠生活质量评分(分值范围为0~144分,分值越低,症状越严重)、直肠肛管测压与排粪造影检查情况。随访时间截至术后12个月(2017年2月)。结果:(1)30例女性患者均顺利完成手术,平均手术时间25(18~34)分,平均术后住院时间6(4~9)天。术后并发症:疼痛20%(6/30)、尿潴留16.7%(5/30)、肛门坠胀感6.7%(2/30)、急便感26.6%(8/30)。其中,患者肛门坠胀感、急便感均于术后1~3月内逐渐减弱并消失,未出现术后出血、感染、直肠阴道瘘、吻合口裂开和肛门失禁等严重并发症。术后随访12月,患者主观感受总有效率为93.3%(28/30),无效率为6.7%(2/30)。(2)全组患者治疗开始前及治疗后手术前Longo ODS评分较为接近(治疗前:32.95±3.22,治疗后手术前:32.85±3.62,t=1.472,P=0.163),但与治疗开始前相比,行改良STARR手术后患者ODS评分下降(t=4.306,P=0.000),其中术后1月ODS评分较术后1周明显下降(13.05±7.49比15±7.17,t=7.322,P=0.000),术后1、3、6和12月时患者ODS评分稳定,差异无统计学意义(F=2.111,P=0.107)。全组患者治疗开始前及术前GIQLI评分无显著差异(治疗前:79.39±17.14,治疗后手术前:76.65±17.56,t=1.735,P=0.096),但与治疗开始前相比,行改良STARR手术后患者GIQLI评分上升(t=4.714,P=0.000),其中术后1月GIQLI评分较术后1周升高(102.26±19.24比91.31±21.35,t=5.628,P=0.000),术后1、3、6和12月时患者GIQLI评分稳定,差异无统计学意义(F=1.211,P=0.313)。(3)与治疗前相比,术后12个月排粪造影检查显示,患者直肠前突及直肠内套叠程度明显改善,其中直肠前突从(34.1±0.4)mm下降至(3.1±0.3)mm(t=6.847,P=0.000)。力排相肛直角从(123.8±6.7)°上升到(134.7±8.5)°,力排时肛直角开大角度从(29.1±3.5)°上升到(37.1±5.3)°,但会阴下降程度、静息相肛直角与术前相比较,无统计学差异(均P0.05)。(4)治疗前后肛管静息压、肛管最大收缩压、直肠排粪压、直肠排粪感觉阈值及直肠最大耐受量等相应直肠肛管测压参数并未显示出明显的差异(均P0.05)。结论:改良经肛吻合器直肠切除术(Improved STARR)联合围手术期盆底生物反馈治疗ODS是安全的、有效的。
[Abstract]:Objective: to evaluate the clinical efficacy and safety of modified transanal stapler rectal partial resection (Improved STARR) combined with pelvic floor biofeedback in the treatment of defecation disorder syndrome (ODS). Methods: the clinical data of 30 female patients with defecation disorder syndrome treated by modified STARR operation and biofeedback during perioperative period from October 2014 to January 2016 in the first Hospital of Jilin University were retrospectively analyzed. All patients underwent a course of pelvic floor biofeedback therapy (20 min/ 10 times as a course of treatment) and then underwent modified STARR operation. After discharge from the hospital, the patients received two courses of pelvic floor biofeedback therapy. The evaluation indexes of curative effect included the general condition of the patients and the complications after operation, the subjective feeling grading of the patients before and after treatment (excellent: no discomfort, good: 1 or 2 times a month with no finger or enema and other auxiliary defecation; Good: three or more times a month with laxatives; poor: symptoms did not improve) Longo ODS score (score range 0 ~ 40, the higher the score, the more serious symptoms), gastrointestinal quality of life score (score range of 0 ~ 144 points, the lower the score, the higher the score, the more serious the symptoms are, the lower the score is, the higher the score is, the more serious the symptoms are. The more serious the symptoms, the more the rectoanal manometry and defecography. The follow-up period was 12 months (February 2017). Results: (1) 30 female patients completed the operation successfully, the average operative time was 25 (18 / 34) and the average postoperative hospitalization time was 6 (4 / 9) days. Postoperative complications: pain 20% (6 / 30), urinary retention 16. 7% (5 / 30), anal bloating 6. 7% (2 / 30), irritation 26. 6% (8 / 30). There were no serious complications such as postoperative bleeding, infection, rectovaginal fistula, anastomotic opening and anal incontinence. The total effective rate of subjective feeling was 93.3% (28 / 30), and the ineffective rate was 6.7% (2 / 30). (_ 2). The Longo ODS scores before and after treatment were similar (before treatment: 32.95 卤3.22, before treatment: 32.85 卤3.62t 1.472P 0.163), but compared with that before treatment. After the modified STARR operation, the ODS score of the patients decreased (t = 4.306 P0. 000), and the ODS score in 1 month after operation was significantly lower than that in the first week (13.05 卤7.49 vs 15 卤7.17). The ODS score of the patients was stable at 1 and 12 months after the operation (F2.111, P0. 107). There was no significant difference in GIQLI scores before and before treatment (1: 79. 39 卤17. 14 before treatment and 1. 735% before operation after treatment), but there was no significant difference between the two groups before and after treatment. However, there was no significant difference between the two groups before and after treatment, but there was no significant difference between the two groups before treatment and before treatment (P < 0. 096). The GIQLI score of the patients undergoing modified STARR operation increased (t = 4.714p 0.000), and the GIQLI score in 1 month after operation was higher than that in the first week after operation (102.26 卤19.24 vs 91.31 卤21.35 t 5.628P 0.000). The GIQLI score was stable at 1 month after operation and 12 months after operation (F1.211P 0.313). (3), and there was no significant difference between the two groups (F1.211P0.313). (3). 12 months after operation, defecography showed that the degree of rectum protrusion and rectum intussusception was significantly improved, in which rectal protrusion decreased from (34.1 卤0.4) mm to (3.1 卤0.3) mm (/ t 6.847). The angle of anal right angle increased from (123.8 卤6. 7) 掳to (134.7 卤8. 5) 掳, and the wide angle of right angle of anal angle increased from (29. 1 卤3. 5) 掳to (37. 1 卤5. 3) 掳. However, the degree of perineum decreased, and there was no significant difference in resting anal right angle between before and after treatment (P0.05). (4). The parameters of rectal anal manometry such as rectal defecation pressure, rectal defecation sensory threshold and rectal maximum tolerance dose did not show significant difference (P0.05). Conclusion: (Improved STARR) combined with pelvic floor biofeedback in perioperative period is safe and effective in the treatment of ODS.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R657.1

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