功能性便秘（functional constipation，FC）是临床常见的消化系统动力障碍性疾病，其中出口梗阻型便秘（outlet obstructive constipation，OOC）为其最常见的动力异常类型。出口梗阻型便秘典型表现为顽固性排便困难，排便费力、无便意或虽便意频繁但排不尽感，排便时间延长，影响生活质量。出口梗阻型便秘的发病机制尚未完全阐明，目前已知与心理障碍、暂时的解剖学梗阻有关。目前，诊断出口梗阻型便秘需进行详尽的病史询问、查体以及相应的影像学检查，包括肛门直肠测压试验，球囊排出试验、动态磁共振成像（MRI）与排粪造影等。OOC应首选非手术治疗，经肛吻合器直肠切除术（STARR）和改良的Bresler术对于直肠前突和直肠内脱垂是有效的手术方式，但必须严格掌握手术适应证。

Surgical strategy of outlet obstructive constipation                     WANG Zhen-jun, YANG Xin-qing. Department of General Surgery, Chaoyang Hospital Affiliated to Capital Medical University, Beijing 100020, China
Corresponding author：WANG Zhen-jun, E-mail: wang3zj@sohu.com
Abstract    Outlet obstructive constipation is observed in approximately half of all patients with functional constipation. Typical symptoms are laborious incomplete and fragmented evacuation in conjunction with heavy straining. The duration of defecation is almost prolonged. Although the symptomatology has been well defined in the literature, the pathophysiology and etiology are still poorly understood. Outlet obstruction is a complex disorder which includes also psychosomatic factors and temporary anatomical obstruction. Currently, evaluation includes detailed history and rectal and pelvic exam together with physiologic tests such as anorectal manometry, balloon expulsion test, defecography, and dynamic MRI. The treatment of OOC has an established place within the field of conservative therapy. The selection of patients of the STARR procedure, Bresler procedure and other operative techniques remains important.