痔手术切断肛门括约肌对肛肠动力学影响的临床研究  

Influence of anal sphincterotomy to anorectal dynamics in the treatment of hemorrhoids

作　　者：李春雨[1] 顾宇[2] 林树森[1] 聂敏 于好[1] 袁鹿[1] 关维雨[1] 袁鹏[1] 宋成飞[1] 王墨飞[1] 王军[1] 

机构地区：[1]中国医科大学附属第四医院肛肠科,沈阳110032 [2]辽宁省鞍山市铁西区人民医院肛肠科 [3]辽宁省肛肠医院三病区

出　　处：《中国医师进修杂志（外科版）》2009年第9期23-25,共3页Chinese Journal of Postgraduates of Medicine

基　　金：辽宁省教育厅基金（20061016）;辽宁省科技攻关立项科研课题（2002225003-8）

摘　　要：目的观察外剥内扎加括约肌切断术与单纯外剥内扎术治疗环形混合痔对肛肠动力学影响的差异。方法采用瑞典生产的肛肠压力测量仪测量外剥内扎加括约肌切断术（治疗组，50例）和单纯外剥内扎术（对照组，52例）术前1d及术后3个月患者的肛管静息压、肛管最大收缩压、直肠感知阈值量、直肠最大耐受量、直肠最大顺应性的变化。结果治疗组术后3个月肛管静息压[（34．7±17.3）mmHg（1mmHg=0．133kPa）]较术前1d[（74．9±14．2）mmHg]明显降低（P〈0．01），对照组术后3个月肛管静息压[（50．1±18．6）mmHg]较术前1d[（763±20．1）mmHg]降低（P〈0．05），但两组术后3个月肛管静息压比较差异有统计学意义（P〈0．05）；两组术后3个月肛管最大收缩压、直肠感知阈值量、直肠最大耐受量以及直肠最大顺应性比较差异无统计学意义（P〉0．05）。结论痔手术切断肛门括约肌使环形混合痔患者的肛管高压状态明显改善，但不会引起肛门失禁，是一种较好的手术方法。Objective To observe the difference of anorectal dynamics between Milligan-Morgan hemorrhoidectomy plus internal sphinctemtomy and simple Milligan-Morgan hemorrhoidectomy in the treatment of annulus mixed hemorrhoids. Method Measured the anal resting pressure,maximal anal contractive pressure, rectal sensation thresholds, maximal rectal tolerable dose and maximal rectal compliance 1 day before and 3 months after Milligan-Morgan hemorrhoidectomy plus internal sphincterotomy （therapy group, 50 cases） and simple Milligan-Morgan hemorrhoidectomy （control group, 52 cases ） by anorectal manometric device made in Sweden. Results The anal resting pressures of therapy group and control group reduced significantly 3 months after operation compared with that 1 day before operation （P 〈 0.01 or 〈 0.05 ） ,but there was significant difference between the two groups in 3 months after operation （P〈 0.05 ）. The maximal anal contractive pressure, rectal sensation thresholds, maximal rectal tolerable dose and maximal rectal compliance were no significant difference between the two groups in 3 months after operation （P 〉0.05）. Conclusion Anal sphincterotomy can change the high anal pressure significantly in the treatment of annulus hemorrhoids without copracrasia, it is a proper operation method.

关 键 词：痔 肛管 外科手术 肛肠动力学 

分 类 号：R657.1[医药卫生—外科学] R657.16[医药卫生—临床医学]