Prognostic and predictive value of interstitial cells of Cajal populations following stapled transanal rectal resection (STARR) in patients with obstructed defecation syndrome.
Prognostic and predictive value of interstitial cells of Cajal populations following stapled transanal rectal resection (STARR) in patients with obstructed defecation syndrome.
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排便梗阻综合征患者经肛直肠吻合器切除术 (STARR) 后 Cajal 群体间质细胞的预后和预测价值
DOI：
10.1093/gastro/goy034
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发表时间：
2018-11
影响因子：
3.6
通讯作者：
Wang JP
中科院分区：
文献类型：
--
作者：
Lin HC;Chen HX;Huang L;Zhu YX;Zhou Q;Li J;Xu YJ;Ren DL;Wang JP
本研究旨在评价吻合器经肛门直肠切除术（STARR）的功能结局，并检查Cajal间质细胞（ICC）群体密度与STARR手术治疗排便阻塞综合征（ODS）患者的疗效之间的关系。全层直肠样本来自50名接受STARR的ODS患者。使用ICC免疫组织化学分析样品。将排粪造影和肛门直肠测压获得的临床和功能参数与20名对照组进行比较。与对照组相比，患者粘膜下、肌内和肌间区ICC均明显减少（P < 0.05）。术前平均Cleveland Consistency评分（CCS）为24.2 ± 4.1，术后1、2、3、4、5年CCS明显下降（P < 0.05）。术后3年，58.3%（28/48）的患者报告了有利结局（CCS ≤ 10）。在单变量分析中，术前指状位（P = 0.017）、ICC-MY细胞数量减少（P = 0.067）、静息肛管压力较高（P = 0.039）和直肠感觉阈值较高（P = 0.073）的患者功能结果较差。多变量分析显示ICC-MY细胞群减少是低不利功能结局的独立预测因子（比值比= 0.097，95%置信区间：0.012-0.766）。STARR取得了可接受的结果，但在更长时间的随访中出现了轻微恶化。直肠标本中ICC数量减少的患者显示出不利的功能结局，其中全层直肠样本的术前组织学评估可能预测STARR后的功能结局。
The present study was designed to evaluate the functional outcome of stapled transanal rectal resection (STARR) and to examine the relationship between the population density of the interstitial cells of Cajal (ICC) and the efficacy of the STARR operation in the management of obstructed defecation syndrome (ODS) patients. Full-thickness rectal samples were obtained from 50 ODS patients who underwent STARR. Samples were analysed using ICC immunohistochemistry. Clinical and functional parameters obtained with defecography and anorectal manometry were compared with 20 controls. ICCs were significantly decreased in patients in the submucosal (SM), intramuscular (IM) and myenteric (MY) regions when compared with the control group (P < 0.05). The mean pre-operative Cleveland Constipation Score (CCS) was 24.2 ± 4.1, whilst the CCS at 1, 2, 3, 4 and 5 years post-operatively decreased significantly (P < 0.05). At 3 post-operative years, 58.3% (28/48) of the patients reported a favorable outcome (CCS ≤ 10). On univariate analysis, the functional results were worse in those with pre-operative digitation (P = 0.017), a decreased ICC-MY cell population (P = 0.067), a higher resting anal canal pressure (P = 0.039) and a higher rectal sensory threshold (P = 0.073). Multivariate analysis showed the decreased ICC-MY cell population was an independent predictor for low unfavorable functional outcome (odds ratio = 0.097, 95% confidence interval: 0.012–0.766). STARR achieved acceptable results at the cost of a slight deterioration over a more prolonged follow-up. Patients with a decreased ICC number in the rectal specimen showed an unfavorable functional outcome where pre-operative histological assessment of a full-thickness rectal sample might predict for the functional outcome following STARR.
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影响因子：
3.9
作者：
Gagliardi, Giuseppe;Pescatori, Mario;Trompetto, Mario
通讯作者：
Trompetto, Mario
影响因子：
2.2
作者：
Patel, Chirag B.;Ragupathi, Madhu;Haas, Eric M.
通讯作者：
Haas, Eric M.
影响因子：
3.3
作者：
Dodi, G;Pietroletti, R;Pescatori, M
通讯作者：
Pescatori, M
影响因子：
2.8
作者：
Naldini, Gabriele;Martellucci, Jacopo;Mascagni, Domenico
通讯作者：
Mascagni, Domenico
影响因子：
3.9
作者：
MELLGREN, A;ANZEN, B;HOLMSTROM, B
通讯作者：
HOLMSTROM, B