三种差异性TST手术疗效的回顾性研究  

Retrospective Comparative Study on the Curative Effects of Three Variable Procedures of TST Surgery

作　　者：顾建华[1] 王金双[1] 

机构地区：[1]江苏省如东县中医院肛肠科,江苏如东226400

出　　处：《中国肛肠病杂志》2015年第12期19-21,共3页Chinese Journal of Coloproctology

摘　　要：为对比三种差异性TST手术治疗痔的近、远期疗效，回顾分析2011年1月至2013年6月行TST治疗的92例痔患者临床资料，其中低位吻合（A组，吻合口距离齿状线1．5～2．0cm）36例，高位吻合（B组，吻合口距离齿状线3．5～4．0cm）31例，高位吻合联合聚桂醇硬化注射（c组，高位吻合后吻合口上方及痔核注射聚桂醇）25例，对比三种方法治疗的患者术后并发症（20d内）、短期疗效（半年内）和中远期疗效（2年以上）。结果显示，1）近、远期疗效：三组患者均顺利完成手术。术后半年，三组患者均无复发；术后2年随访，A组（5．5％）、C组（4．0％）远期复发率明显低于B组（16．1％），P〈0．05；但A组与C组比较差异无统计学意义，P〉0．05。2）术后并发症：（1）肛门疼痛。三组术后肛门疼痛情况比较差异无统计学意义，P〉0．05。（2）肛门坠胀。A组术后肛门坠胀发生率（19．5％）明显高于B组（9．7％）、C组（8．0Yoo），P〈0．05；B、C组比较差异无统计学意义，P〉0．05。（3）便血。A组（11．1％）和B组（12．9％）术后便血发生率明显高于C组（0），P〈0．05；但A组和B组比较差异无统计学意义，P〉0．05。结果表明，三种方法相比，高位吻合联合聚桂醇注射治疗痔效果最好。低位吻合虽然近期并发症相对较高，但其远期疗效较好，对于脱垂较重、经济能力有限、耐受力较强者，可行此术式。对于脱出症状严重，且无明显出血的痔患者，行单纯高位吻合即可取得较好的近、远期疗效。临床工作中，应根据临床效果、手术并发症及经济承受力三方面因素，选择适合患者的术式。In order to compare the short- and long-term effects of three variable procedures of TST surgery for hemorrhoids,author retrospectively analyzed the clinical data of 92 hemorrhoids patients who had received TST surgery from Jan. 2011 to June 2013 in author＇s department included 36 cases treated with low anastomosis（group A,the distance of stoma far from dentate line is 1.5-2.0 cm）,31 cases treated with high anastomosis（group B,the distance is 3.5-4.0 cm）,and 25 cases treated with high anastomosis combined with injecting poly-lauromacrogol to sclerose hemorrhoids（group C,injecting poly-lauromacrogol at the upper of highly anastomosed stoma and at hemorrhoids-mass）, compared postoperative complication（within 20 days）,short-term effect（within 0.5 year） and mid-long-term effects（more than 2 years） between the 3 procedures.As results, 1）short-and long-term effects： the patients of three groups all received surgery smoothly, and did not suffer from＇ recurrence 0.5 year after operation;within 2 years follow-up duration the long-term recurrence rate of group A（5.5%） and C（4.0%） was significantly lower than that of group B 16. 1%（ P 〈0.05）,but there was no statistical difference between group A and C（ P 〉0.05）.2）Postopeative complication ： （1） in pain of anus,there was no statistical difference between three groups（ P 〉0.05） ; （2）in anal tenesmus,the incidence of group A（19.5%） was significantly higher than that of groupB＇（9.7%） and C（8.0%）（ P 〈0.05）,but between group B and C there was no statistical difference（ P 〉0.05） ; （3）in hematochezia,the incidence of group A（11.1%） and B（12.9%） was significantly higher than that of group C （0 %）（ P 〈0.05）, but between group A and B there was no statistical difference （ P 〉 0.05）. Comparing three procedures show that high anastomosis combined with injecting poly-lauromacrogol is of the most efficacy;as to low anastomosis,if even its short-term complication inc

关 键 词：痔 TST 聚桂醇 低位吻合 高位吻合 联合术式 

分 类 号：R686.5[医药卫生—骨科学]