痔上黏膜环切钉合术治疗重度痔  

The clinical application of stapled prolapsectomy(PPH) for severe hemorrhoids: a report of 153 cases

作　　者：李胜龙[1] 尹廷宝[1] 杨俊明[1] 鲍铭[1] 康东[1] 

机构地区：[1]南方医科大学南方医院肛肠外科,广东广州510515

出　　处：《中国普通外科杂志》2006年第9期689-692,共4页China Journal of General Surgery

摘　　要：目的 探讨痔上黏膜环切钉合术（PPH）的操作方法和疗效.方法 根据患者痔核大小、痔核性质、合并症、齿状线状况等具体情况采用PPH个体化治疗重度痔患者153例,分析其手术操作技巧与疗效、术后并发症的关系.结果 切除组织宽度为2.1～4.6cm,平均3.5cm.脱出痔组织立即全部回缩.吻合口渗血49例,搏动性出血12例,均在直视下缝合止血.不同程度的排尿困难、腹胀不适、疼痛、肛内坠胀便意感和灼热感是患者手术当天的主要症状,随访1～40个月无吻合口狭窄、肛门失禁及脱出复发.对效果感到非常满意者87例,满意者63例,基本满意者3例.结论 PPH处理重度痔宜个体化,术中注意操作技巧,方可取得回缩好、避免并发症及提高患者满意度的理想效果.Objective To investigate the operative technique and efficacy of PPH for severe hemorrhoids. Methods The clinical data of 153 cases of severe hemorrhoids treated by PPH, individualized according to size and nature of the piles , concomitant morbidities and conditions at the dentate line , and analysis of the relevance between operative technique and clinical efficacy as well as postoperative complications, were revieuled retropectively. Results All of the prolapsed tissue retracted immediately. Bleeding at the anastomotic site occurred in 49 cases , pulsatile bleeding in 12 cases , all of which were sutured under direct vision with cessation of bleeding. The width of excised-tissue was 2. 1 -4. 6cm （average 3. 5cm）. The main symptoms of patients on the 1 st post-operation day were abdominal distention caused by dysuria, pain, and tenesmus and burning sensation. At followup of 1 -40 months, there was no stenosis of stoma, anal incontinence or recurrence of prolapse. After operation, a very satistactory result was achieved in 87 cases, satisfactory in 63 cases and mostly satisfactory in 3 cases. Conclusions In order to achieve ideal results with good retraction of tissues, avoidance of complications and improve patient satisfactory rate, the use of PPH for severe hemorrhords must be individualized and technical skill during operation are important.

关 键 词：痔/外科学 黏膜环切钉合术 

分 类 号：R657.8[医药卫生—外科学]