吻合器痔上粘膜环切术并发症的原因及处理  

Cause Analysis and Management of Complications of Procedure for Prolapse and Hemorrhoids

作　　者：黄忠诚[1] 陈超武[1] 成世盈[1] 苏冀[1] 刘冬保[2] 尹明祥[2] 陈新文[2] 刘清安[2] 

机构地区：[1]湖南省人民医院肛肠外科,长沙410005 [2]湖南省常德市第一人民医院普外科,常德415003

出　　处：《中国现代手术学杂志》2007年第6期430-432,共3页Chinese Journal of Modern Operative Surgery

摘　　要：目的分析吻合器痔上粘膜环切术（procedure for prolapse and hemorrhoids，PPH）治疗Ⅲ至Ⅳ度环状混合痔并发症发生的原因及防治措施。方法回顾性分析2002年5月至2006年12月行PPH术的96例Ⅲ至Ⅳ度环状混合痔临床资料，分析手术并发症发生的原因及处理。结果96例患者均一次击发成功，切除直肠粘膜环完整，平均手术时间13．5（10～20）min，平均住院时间4（3～10）d。术中下腹短时疼痛43例；尿潴留58例；肛门疼痛46例（轻度30例，中度10例，重度6例）；1周内出血6例，再手术缝扎止血3例，1周后出血3例，手术止血1例；外痔团不回缩7例；肛门挛缩、坠胀5例；排便障碍1例。87例平均随访41（6～62）个月，疗效满意81例，6例复发。无肛门狭窄、大便失禁、肛门外翻和直肠阴道瘘等并发症。结论PPH是治疗Ⅲ至Ⅳ度环状混合痔病的有效方法，但也存在一些手术并发症，正确选择病例、提高手术操作水平、根据不同的病情采用不同的手术技巧，在预防和处理PPH手术并发症中有着重要的临床意义。Objective To explore the causes, management and prevention of complications of procedure for prolapse and hemorrhoids （PPH）. Mothods 96 circumferential mixed hemorrhoids cases with degree Ⅲ or Ⅳ underwent PPH were reviewed. Result All cases were succeeded with integrated rectal mucosa resection. The operative time was 10 to 20 minutes and the hospital stay was 3 - 10 days. The complications occurred, including 43 of short-term hypogastralgia during the operation, 58 of uroschesis,46 of anus pain （ mild pain in 30, moderate in 10 and severe in 6）, 9 of postoperative anastomotic hemorrhage, 7 of cutaneous hemorrhoids incompletely retraction, 5 of crispation and discomfort, and 1 of dysporia. 87 were followed up for 6 to 62 months, 81 were satisfied, and 6 were relapsed. No anal stenosis, incontinence, valgus or rectovaginal fistula occurred. Conclusions PPH is an effective procedure for circularity mixed hemorrhoids with degree Ⅲ or Ⅳ, nevertheless some correlated complications existed. The managements of selecting patient correctly, operating skillfully is of great clinical significance in the prevention and treatment of PPH complications.

关 键 词：痔上粘膜环切术 痔 并发症 

分 类 号：R657.1[医药卫生—外科学]