李艳聪 李帅军

[摘要] 目的 探讨吻合器经肛直肠切除术（STARR）联合耻骨直肠肌挂线术治疗出口梗阻型便秘的疗效。 方法 选择2018年9月至2020年3月湖南中医药大学第二附属医院痔瘘便秘专科住院部收治的出口梗阻型便秘患者68例，采用STARR联合耻骨直肠肌挂线术进行治疗。比较治疗前后的Wexner评分、排便时间及肛门直肠测压。 结果 患者术后Wexner评分较术前明显减小、排便时间缩短;肛门直肠测压显示，肛管静息压、肛管最大收缩压、肛管舒张压均有不同程度的改善，差异有统计学意义（P<0.05）。 结论 STARR联合耻骨直肠肌挂线术治疗出口梗阻型便秘治疗效果显著，值得推广。

[关键词] 出口梗阻型便秘;吻合器经肛直肠切除术;耻骨直肠肌挂线术;手术治疗

[Abstract] Objective To explore the effect of stapled transanal rectal resection（STARR） combined with thread-drawing of puborectal muscle in the treatment of outlet obstructive constipation. Methods A total of 68 patients with outlet obstructive constipation who were admitted to the hemorrhoid and constipation specialist department of the Second Affiliated Hospital of Hunan University of Chinese Medicine from September 2018 to March 2020 were selected and treated with STARR combined with puborectal muscle thread-drawing. The Wexner score， defecation time and anorectal pressure measurement before and after treatment were compared. Results The Wexner score of the patient was significantly reduced after the operation compared with that before the operation， the defecation time was shorter than that before surgery; anorectal pressure measurement showed that the resting pressure， the maximum systolic pressure， and the diastolic pressure of the anal canal all improved to varying degrees， the differences were statistically significant（P<0.05）. Conclusion STARR combined with thread-drawing of puborectal muscle has a significant effect in the treatment of outlet obstructive constipation， and it is worthy of promotion.

[Key words] Outlet obstructive constipation; Stapled transanal rectal resection; Thread-drawing of puborectal muscle; Surgical treatment

出口梗阻型便秘（Outlet obstructive constipation，OOC）包含盆底肌松弛綜合征（Pelvic floor syndrome，PFS）和盆底肌失弛缓综合征（Unrelaxed pelvic floor syndrome，UPS）两类[1]。其主要症状表现为排便费力、肛门阻塞感、排便不尽感等，有时需用手辅助排便[2]，对患者的日常生活影响极大，且女性发病率高于男性[3]。在药物治疗、生物反馈治疗等保守治疗仍未能改善排便困难的情况下，可采取手术治疗[4]，目前国内的手术方式以痔上黏膜环形切除钉合术（Procedure for prolapse and hemorrhoid，PPH）应用最为广泛，PPH术通过经肛吻合器切除多余黏膜、修补直肠前突，达到改善排便的效果[5]，但OOC病因复杂，常由多种因素引起，以单一手术方式治疗某一因素常疗效欠佳[6]。因此，本研究采用吻合器经肛直肠切除术（Stapled transanal rectal resection，STARR）联合耻骨直肠肌挂线术，通过两种术式结合的方式同时治疗PFS和UPS，效果确切，现报道如下。

1 资料与方法

1.1一般资料

选取2018年9月至2020年3月湖南中医药大学第二附属医院痔瘘便秘专科住院部收治的OOC患者68例，其中男21例，女47例;年龄35～67岁，平均（53.2±4.3）岁;病程4～10年，平均（6.8±1.8）年。……