Comparison of the medium- and long-term clinical effects of procedure for prolapse and hemorrhoids combined with Block operation in treatment of obstructed defecation syndrome_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Xiaojun ¹ , FAN Leitao ² ,  LI Chunyu ³

1. The Third Department of General Surgery, Chaoyang City Central Hospital, Chaoyang, Liaoning 122000, P. R. China;
2. Anorectal Department, Chaoyang City Central Hospital, Chaoyang, Liaoning 122000, P. R. China;
3. Department of Anus and Intestine Surgery, The Fourth Affiliated Hospital of China Medical University, Shengyang 110032, P. R. China;

Corresponding author：

LI Chunyu, Email: lcy133000@163.com

Keywords：

obstructed defecation syndrome; procedure for prolapse and hemorrhoids; Block operation; rectocele; clinical effect

DOI：

10.7507/1007-9424.201708027

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Objective To explore the medium- and long-term clinical effects of procedure for prolapse and hemorrhoids (PPH) combined with Block operation for obstructed defecation syndrome (ODS). Methods Clinical data of 187 patients with ODS caused by rectocele (RE) who received PPH+Block operation or pure PPH operation in The Chaoyang City Central Hospital from Mar. 2011 to May. 2013, were collected retrospectively, in which 95 patients underwent PPH+Block operation (PPH+Block group) and 92 patients underwent PPH operation (PPH group). Compared the postoperative Longo’s score, postoperative clinical effect, operative effect, and recurrence rate between the 2 groups. Results ① The postoperative Longo’s score: the postoperative Longo’s scores of the PPH+Block group were both lower than those of the PPH group at 1- and 3-year after operation (P<0.05). ② Postoperative curative effect: the total effective rate of the PPH+Block group and the PPH group were both 100%, but the clinical effect of the the PPH+Block group was better than that of the PPH group (Z=–10.15, P<0.05). ③ Operative effect: there was no statistical significance on operative time, intraoperative blood loss, returned to normal activity time, hospital stay, and postoperative visual analogy score (VAS) between the 2 groups (P>0.05). In addition, there were no statistical significance on the incidences of urinary retention, hematochezia, exhaust anal incontinence, and anal fissure between the 2 groups (P>0.05), but the incidence of urgent or high anal straining feeling in the PPH+Block group was significantly higher than that of the PPH group (P<0.05). ④ Medium- and long-term recurrence rate: the recurrence rate of 1-year after operation was similar between these2 groups (P>0.05), but the recurrence rate of 3-year after operation in the PPH+Block group was significantly lower than that of the PPH group (P<0.05). Conclusions The medium clinical effect has no obvious difference between PPH+Block and PPH operation, but the long-term recurrence rate of the former is lower than that of the latter, and the medium- and long-term effect is stable in PPH+Block operation for ODS caused by RE.

Citation： LI Xiaojun, FAN Leitao, LI Chunyu. Comparison of the medium- and long-term clinical effects of procedure for prolapse and hemorrhoids combined with Block operation in treatment of obstructed defecation syndrome. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(2): 202-206. doi: 10.7507/1007-9424.201708027 Copy

1.	Higgins PD, Johanson JF. Epidemiology of constipation in North America: a systematic review. Am J Gastroenterol, 2004, 99(4): 750-759.
2.	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. Surg Innov, 2008, 15(2): 105-109.
3.	Boccasanta P, Venturi M, Roviaro G. What is the benefit of a new stapler device in the surgical treatment of obstructed defecation? Three-year outcomes from a randomized controlled trial. Dis Colon Rectum, 2011, 54(1): 77-84.
4.	Madbouly KM, Abbas KS, Hussein AM. Disappointing long-term outcomes after stapled transanal rectal resection for obstructed defecation. World J Surg, 2010, 34(9): 2191-2196.
5.	袁鹿, 郭剑波, 林树森, 等. 经肛吻合器直肠黏膜切除术与经直肠闭式修补术治疗直肠前突的对比研究. 中国普外基础与临床杂志, 2012, 19(2): 151-156.
6.	Drossman DA. The functional gastrointestinal disorders and the Rome III process. Gastroenterology, 2006, 130(5): 1377-1390.
7.	李春雨. 肛肠病学. 北京: 高等教育出版社, 2013: 93, 189-190.
8.	李春雨, 张有生. 实用肛门手术学. 沈阳: 辽宁科技出版社, 2005: 229-230.
9.	袁鹏, 范雷涛, 李春雨. 吻合器痔上黏膜环形切除钉合术治疗 104 例直肠前突所致便秘的疗效. 中国普外基础与临床杂志, 2013, 20(8): 940-942.
10.	Tong DM, Zhou YT, Wang GS, et al. Early prediction and outcome of septic encephalopathy in acute stroke patients with nosocomial coma. J Clin Med Res, 2015, 7(7): 534-539.
11.	Choi JS, Hwang YH, Salum MR, et al. Outcome and management of patients with large rectoanal intussusception. Am J Gastroenterol, 2001, 96(3): 740-744.
12.	Petersen S, Hellmich G, Schuster A, et al. Stapled transanal rectal resection under laparoscopic surveillance for rectocele and concomitant enterocele. Dis Colon Rectum, 2006, 49(5): 685-689.
13.	周亮, 洪流东, 陈富. 经肛门镜下吻合器治疗直肠前突的疗效及生活质量变. 中国国中西医结合外科杂志, 2015, 21(1): 59-61.
14.	张斌, 丁健华, 张萌, 等. 经肛吻合器直肠切除术治疗出口梗阻型便秘的并发症分析. 中华胃肠外科杂志, 2011, 14(12): 934-937.
15.	谭书锦, 别君. PPH 治疗直肠前突所致出口梗阻性便秘的近远期疗效评估. 中国医药导刊, 2014, 2(16): 193-194, 196.
16.	张正国, 杨光, 杨勇, 等. TST STARR+术治疗出口梗阻型便秘的临床研究. 中华胃肠外科杂志, 2016, 19(1): 88-90.
17.	Sciaudone G, Di Stazio C, Guadagni I, et al. Rectal diverticulum: a new complication of STARR procedure for obstructed defecation. Tech Coloproctol, 2008, 12(1): 61-63.
18.	Zhang ZG, Yang G, Pan D, et al. Efficacy of endoscopic stapled transanal rectal resection for the treatment of rectocele. Eur Rev Med Pharmacol Sci, 2014, 18(24): 3921-3926.
19.	李凤霞, 张立涛, 陈志仁. 老年女性直肠前突合并直肠内脱垂 118 例的治疗体会. 中国老年学杂志, 2007, 27(9): 898-899.
20.	韩飞, 段晓, 李鹏, 等. 直肠脱垂 56 例诊治体会. 中国医师进修杂志, 2013, 36(6): 63-64.
21.	袁鹏, 李春雨, 王墨飞. 吻合器痔上黏膜环形切除钉合术治疗老年女性直肠前突 63 例. 中国普外基础与临床杂志, 2011, 18(12): 1317-1318.
22.	Pescatori M, Zbar AP. Reinterventions after complicated or failed STARR procedure. Int J Colorectal Dis, 2009, 24(1): 87-95.
23.	Dodi G, Pietroletti R, Milito G, et al. Bleeding, incontinence, pain and constipation after STARR transanal double stapling rectotomy for obstructed defecation. Tech Coloproctol, 2003, 7(3): 148-153.
24.	胡晟云, 王时俊, 徐纪中, 等. PPH 联合直肠黏膜柱状缝扎术治疗出口梗阻性便秘的临床效果分析. 河南医学研究, 2017, 26(6): 997-999.
25.	项雄华, 卿艳平, 吴为明, 等. 痔上黏膜环切术联合经直肠直肠前突闭式修补术治疗直肠前突临床疗效观察. 中国医师进修杂志, 2014, 37(32): 44-46.

1. Higgins PD, Johanson JF. Epidemiology of constipation in North America: a systematic review. Am J Gastroenterol, 2004, 99(4): 750-759.
2. 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. Surg Innov, 2008, 15(2): 105-109.
3. Boccasanta P, Venturi M, Roviaro G. What is the benefit of a new stapler device in the surgical treatment of obstructed defecation? Three-year outcomes from a randomized controlled trial. Dis Colon Rectum, 2011, 54(1): 77-84.
4. Madbouly KM, Abbas KS, Hussein AM. Disappointing long-term outcomes after stapled transanal rectal resection for obstructed defecation. World J Surg, 2010, 34(9): 2191-2196.
5. 袁鹿, 郭剑波, 林树森, 等. 经肛吻合器直肠黏膜切除术与经直肠闭式修补术治疗直肠前突的对比研究. 中国普外基础与临床杂志, 2012, 19(2): 151-156.
6. Drossman DA. The functional gastrointestinal disorders and the Rome III process. Gastroenterology, 2006, 130(5): 1377-1390.
7. 李春雨. 肛肠病学. 北京: 高等教育出版社, 2013: 93, 189-190.
8. 李春雨, 张有生. 实用肛门手术学. 沈阳: 辽宁科技出版社, 2005: 229-230.
9. 袁鹏, 范雷涛, 李春雨. 吻合器痔上黏膜环形切除钉合术治疗 104 例直肠前突所致便秘的疗效. 中国普外基础与临床杂志, 2013, 20(8): 940-942.
10. Tong DM, Zhou YT, Wang GS, et al. Early prediction and outcome of septic encephalopathy in acute stroke patients with nosocomial coma. J Clin Med Res, 2015, 7(7): 534-539.
11. Choi JS, Hwang YH, Salum MR, et al. Outcome and management of patients with large rectoanal intussusception. Am J Gastroenterol, 2001, 96(3): 740-744.
12. Petersen S, Hellmich G, Schuster A, et al. Stapled transanal rectal resection under laparoscopic surveillance for rectocele and concomitant enterocele. Dis Colon Rectum, 2006, 49(5): 685-689.
13. 周亮, 洪流东, 陈富. 经肛门镜下吻合器治疗直肠前突的疗效及生活质量变. 中国国中西医结合外科杂志, 2015, 21(1): 59-61.
14. 张斌, 丁健华, 张萌, 等. 经肛吻合器直肠切除术治疗出口梗阻型便秘的并发症分析. 中华胃肠外科杂志, 2011, 14(12): 934-937.
15. 谭书锦, 别君. PPH 治疗直肠前突所致出口梗阻性便秘的近远期疗效评估. 中国医药导刊, 2014, 2(16): 193-194, 196.
16. 张正国, 杨光, 杨勇, 等. TST STARR+术治疗出口梗阻型便秘的临床研究. 中华胃肠外科杂志, 2016, 19(1): 88-90.
17. Sciaudone G, Di Stazio C, Guadagni I, et al. Rectal diverticulum: a new complication of STARR procedure for obstructed defecation. Tech Coloproctol, 2008, 12(1): 61-63.
18. Zhang ZG, Yang G, Pan D, et al. Efficacy of endoscopic stapled transanal rectal resection for the treatment of rectocele. Eur Rev Med Pharmacol Sci, 2014, 18(24): 3921-3926.
19. 李凤霞, 张立涛, 陈志仁. 老年女性直肠前突合并直肠内脱垂 118 例的治疗体会. 中国老年学杂志, 2007, 27(9): 898-899.
20. 韩飞, 段晓, 李鹏, 等. 直肠脱垂 56 例诊治体会. 中国医师进修杂志, 2013, 36(6): 63-64.
21. 袁鹏, 李春雨, 王墨飞. 吻合器痔上黏膜环形切除钉合术治疗老年女性直肠前突 63 例. 中国普外基础与临床杂志, 2011, 18(12): 1317-1318.
22. Pescatori M, Zbar AP. Reinterventions after complicated or failed STARR procedure. Int J Colorectal Dis, 2009, 24(1): 87-95.
23. Dodi G, Pietroletti R, Milito G, et al. Bleeding, incontinence, pain and constipation after STARR transanal double stapling rectotomy for obstructed defecation. Tech Coloproctol, 2003, 7(3): 148-153.
24. 胡晟云, 王时俊, 徐纪中, 等. PPH 联合直肠黏膜柱状缝扎术治疗出口梗阻性便秘的临床效果分析. 河南医学研究, 2017, 26(6): 997-999.
25. 项雄华, 卿艳平, 吴为明, 等. 痔上黏膜环切术联合经直肠直肠前突闭式修补术治疗直肠前突临床疗效观察. 中国医师进修杂志, 2014, 37(32): 44-46.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Comparison of the medium- and long-term clinical effects of procedure for prolapse and hemorrhoids combined with Block operation in treatment of obstructed defecation syndrome

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