STARR在女性出口阻塞型便秘中的应用(2)
此外，还应注意以下几点：①手术时要保护好直肠前壁，尤其是老年女性，术中采用较窄的脑压板，效果良好。②直肠两个吻合口不能重叠和残缺。术中采用伞状缝合可降低重叠的情况。③术后并发症有术后疼痛、肛门坠胀、尿潴留、出血、感染、直肠阴道瘘。前三种较常见，对症处理后可完全缓解。后三种很少见，但正因为STARR术式不同于PPH，是直肠全层的切除和吻合，所以发生直肠阴道瘘的几率要高于PPH，也是最严重的并发症，这都要求术中操作必须注意保护阴道后壁。④手术需要2把PPH吻合器，给患者经济上带来很大不便，术前做好相关交代。⑤出口阻塞型便秘的解剖和生理紊乱相当复杂，没有哪一种治疗方法取得了整体的优势[4]。对STARR的评价也没有“金标准”作为对照。虽然目前没有哪一种治疗方法像STARR一样解决出口阻塞型便秘的结构异常，但是对出口阻塞型便秘的患者进行手术应持审慎的态度，更何况STARR存在潜在严重并发症的风险。
[参考文献]
[1]Scott R, Mellgren A. Constipation and obstructed defecation [J]. Clin Colon Rectal Surg,2007,20(2):110-117.
[2]Longo A. Obstructed defecation because of rectal pathologies. Novel surgical treatment: double stapled transanal rectal resection (STARR) [C] Florida: Proceedings of the 14th Annual International Colorectal Disease Symposium,2004:13-15.
[3]Zhang B, Ding JH, Yin SH, et al. Stapled transanal rectal resection for obstructed defecation syndrome associated with rectocele and rectal intussusception [J]. World J Gastroenterol,2010,16(20):2542-2548.
[4]Farouk R, Bhardwaj R, Phillips RKS, et al. Stapled transanal resection of the rectum (STARR) for the obstructed defaecation syndrome [J]. Ann R Coll Surg Engl,2009,91(4):287-291.
(收稿日期：2010-11-09), 百拇医药(于登峰 张克忠 张文俊 董毅 刘艳茹 孟剑红)
[参考文献]
[1]Scott R, Mellgren A. Constipation and obstructed defecation [J]. Clin Colon Rectal Surg,2007,20(2):110-117.
[2]Longo A. Obstructed defecation because of rectal pathologies. Novel surgical treatment: double stapled transanal rectal resection (STARR) [C] Florida: Proceedings of the 14th Annual International Colorectal Disease Symposium,2004:13-15.
[3]Zhang B, Ding JH, Yin SH, et al. Stapled transanal rectal resection for obstructed defecation syndrome associated with rectocele and rectal intussusception [J]. World J Gastroenterol,2010,16(20):2542-2548.
[4]Farouk R, Bhardwaj R, Phillips RKS, et al. Stapled transanal resection of the rectum (STARR) for the obstructed defaecation syndrome [J]. Ann R Coll Surg Engl,2009,91(4):287-291.
(收稿日期：2010-11-09), 百拇医药(于登峰 张克忠 张文俊 董毅 刘艳茹 孟剑红)