吻合器痔上黏膜环切钉合术并发症分析  

Complications after procedure for prolapse and hemorrhoids for circular hemorrhoids

作　　者：朱军[1] 丁健华[1] 赵克[1] 张斌[1] 赵勇[1] 汤海燕[1] 赵玉涓[1] 

机构地区：[1]第二炮兵总医院肛肠外科全军肛肠病专病中心,北京100088

出　　处：《中华胃肠外科杂志》2012年第12期1252-1255,共4页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的探讨吻合器痔上黏膜环切钉合术（PPH）后围手术期及远期并发症的发生情况。方法回顾性分析2002年1月至2011年12月间第二炮兵总医院采用PPH治疗2152例环状内痔和环状混合痔病例的临床资料．统计围手术期及术后远期并发症发生情况。结果术后中位随访73个月．术后早期出现急性尿储留360例（16．7％），给予短时留置导尿处理；吻合口出血45例（2．1％），予以再次手术缝扎或镜下电凝、止血夹止血；肛门会阴部持续性疼痛30例（1．4％），给予局部对症或取出吻合钉处理：血栓性外痔形成28例（1．2％），给予保守治疗或行血栓性外痔剥离术治疗：所有患者均治愈。术后远期并发症包括轻度肛门失禁112例（6．3％），肛门坠胀和排粪急迫感50例（2．8％），予以保守治疗和功能锻炼，症状恢复；吻合口狭窄4例（0．2％），予以扩肛治疗后治愈。术后复发82例（4．6％），其中28例再次行PPH治愈：54例保守治疗后症状好转。结论PPH治疗环状内痔和环状混合痔比较安全。Objective To investigate the perioperative and postoperative long-term complications of procedure for prolapse and hemorrhoids （PPH） for the treatment of circular internal hemorrhoids and circular mixed hemorrhoids. Methods A retrospective study was performed in 2152 patients with circular internal hemorrhoids and circular mixed hemorrhoids eligible for PPH from January 2002 to December 2011. The perioperative and postoperative long-term complications were recorded and assessed. Results The median length of follow-up was 73 months. Perioperative complications and adverse events were reported including acute urinary retention （n=360, 16.7%） which was managed by temporary catbether indwelling, anastomotic bleeding （n=45, 2.1%） managed by surgical or endoscopic procedures, chronic anoperineal sustained pain （n=30, 1.4%） managed by local treatment or stapler removal, and thrombosed external hemorrhoid （n=28, 1.2%） managed by conservative treatment or resection. Long-term postoperative complications were reported including mild fecal incontinence（n= 112, 6.3%）, postoperative recurrence（n=82, 4.6%）, anal distention and defeeatory urgency（n=50, 2.8%）, anastomotic stenosis （n=4, 0.2%）. Postoperative recurrence developed in 82 patients （4.6%）, 28 of whom were managed by repeat PPH and 54 by conservative treatment. Conclusion PPH appears to be a safe technique for patients with circular internal hemorrhoids and circular mixed hemorrhoids.

关 键 词：吻合器痔上黏膜环切钉合术 内痔 混合痔 术后并发症 

分 类 号：R657.1[医药卫生—外科学]