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目的：探讨部分吻合器经肛门直肠切除术（STARR术）联合Bresler术治疗直肠前突合并直肠内套叠的疗效。方法前瞻性纳入2013年1月至2014年12月间杭州市第三人民manbet官网登录 肛肠科收治的60例确诊为直肠前突合并直肠内套叠的出口梗阻型便秘患者，采用随机数字表法随机分成联合手术组（29例）和STARR术组（31例），前者采用部分STARR术联合Bresler术，即直肠后壁2／3用STARR的方法横向切除钉合，前壁1／3采用Bresler术纵向切除钉合黏膜；后者采用单纯STARR术。比较两组患者术中情况、术后并发症、术后3月和6月时患者Wexner便秘评分、患者对手术的满意度以及术后6月时的直肠前突情况。结果两组患者年龄和经阴道分娩史者比例差异均无统计学意义（P ＞0.05）。联合手术组手术时间为（31.2±5.4） min，长于STARR术组的（28.7±4.0） min，差异有统计学意义（t＝2.127， P ＝0.038）。两组患者在术中出血量、术后住院时间、术后疼痛需服用止痛药例数、术后出血需再次缝扎止血的例数、直肠阴道瘘和肛门坠胀感方面的差异均无统计学意义（均P ＞0.05）。术后3月Wexner便秘评分比较，两组差异无统计学意义[（6.72±1.19）分比（7.32±1.25）分，t ＝－1.896， P ＝0.063），术后6月Wexner便秘评分比较，联合手术组明显优于STARR术组[（6.90±1.42）分比（7.74±1.26）分， t ＝－2.463， P ＝0.018]。术后3月患者满意率比较，两组差异无统计学意义（χ2＝5.743，P ＝0.125），术后6月时的满意率比较，联合手术组明显高于STARR术组[93.1%（27／29）比67.7%（21／31），χ2＝8.247， P ＝0.041]。排粪造影显示，术前两组直肠前突差异无统计学意义（t＝0.262， P ＝0.794），术后6月复查排粪造影，联合手术组前突程度明显轻于STARR术组[（0.7±0.2） cm比（0.9±0.2） cm， t ＝－2.527， P ＝0.014]。结论与STARR术相比，部分STARR术联合Bresler术可能是治疗直肠前突合并直肠内套叠的更好选择。

Objective To evaluate the efficacy of partial stapled transanal rectal resection (part-STARR) combined with Bresler procedure in the treatment of obstructed defecation syndrome (ODS) associated with rectocele and internal rectal intussusception (IRI), and compare with STARR. Methods A randomized controlled study from January 2013 to December 2014 was undertaken. Sixty female patients with ODS caused by rectocele and IRI were prospectively enrolled and randomly divided into trial group (29 cases) receiving part-STARR combined with Bresler procedure, and control group (31 cases) undergoing STARR only. For patients in trial group, two thirds of posterior rectal wall were stapled with STARR methods and one third of anterior with Bresler procedure , while for those in control group, only STARR was performed. Intra-operational status, postoperative complications, Wexner constipation score and patient satisfaction 3 months and 6 months after operation , and rectocele defecography 6 months after operation were compared between the two groups. Results The average operation time of trial group was longer than that of control group [(31.2 ± 5.4) minutes vs. (28.7 ± 4.0) minutes, t=2.127, P=0.038]. There were no significant differences in intra-operative blood loss, postoperative hospital stay and complications(pain, postoperative bleeding, rectovaginal fistula, feeling of tenesmus and swelling) between the two methods (all P > 0.05). There were no significant differences in the Wexner score of constipation between the two groups before operation and 3 months after operation (6.72 ± 1.19 vs. 7.32 ± 1.25, t = -1.896, P = 0.063), while the Wexner score of trial group was significantly lower 6 months after operation (6.90 ± 1.42 vs. 7.74 ± 1.26, t=-2.463, P=0.018). Patient satisfaction between two groups was not significantly different 3 months after operation (χ2=5.743, P=0.125), while trial group had better satisfaction 6 months after operation [93.1%(27/29) vs. 67.7%(21/31), χ2= 8.247, P = 0.041]. There was no difference in depth of rectocele on defecography between the two groups before operation, while rectocele was significantly improved 6 months after operation [(0.7 ± 0.2) cm vs. (0.9 ± 0.2) cm, t=2.527, P=0.014]. Conclusion Partial STARR combined with Bresler procedure in the treatment of ODS associated with rectocele and IRI has better efficacy than STARR only.