PPH术中采用伞形缝合法治疗Ⅲ～Ⅳ度环状脱垂内痔的临床效果观察  

Effect of umbrella suture in PPH for treating stage Ⅲ～Ⅳ internal hemorrhoids with circular prolapse

作　　者：忻颖[1] 姜辉勇[1] 高玮[1] 纪昉 傅传刚[1] Xin Ying;Jiang Huiyong;Gao Wei;Ji Fang;Fu Chuangang(Department of Colorectal Surgery,Shanghai East Hospital,Affiliated Hospital of Tongji University,Shanghai,200120,China)

机构地区：[1]同济大学附属东方医院胃肠肛肠外科,上海200120

出　　处：《结直肠肛门外科》2018年第6期575-578,共4页Journal of Colorectal & Anal Surgery

摘　　要：目的探讨伞形缝合法应用在吻合器痔上黏膜环切钉合术(PPH)治疗Ⅲ～Ⅳ度环状脱垂内痔中的临床效果。方法选择本科室2015年8月至2017年3月收治的144例Ⅲ～Ⅳ度环状脱垂内痔患者,按就诊单双号顺序随机分为两组,均采用PPH术式,对照组(n=76)采用单荷包两点牵引法,观察组(n=68)采用伞形缝合法。比较两组手术相关情况、术后并发症情况及术后1年复发率。结果观察组术中出血量少于对照组,标本最大宽度大于对照组,标本最宽与最窄差值大于对照组(均P <0.05),两组手术时间、住院天数差异均无统计学意义(均P> 0.05)。观察组痔核回缩不全发生率低于对照组(P <0.05),两组术后吻合口出血及术后疼痛发生率差异均无统计学意义(均P> 0.05)。两组术后1年复发率差异无统计学意义(P> 0.05)。结论与单荷包两点牵引法相比,PPH术治疗Ⅲ～Ⅳ度环状脱垂内痔术中采用伞形缝合法出血量少、手术切除标本宽度及标本最宽与最窄差值更大,术后痔核回缩情况更好。Objectives To investigate the effect of using umbrella suture in Procedure for Prolapse and Hemorrhoids(PPH)for treating stage III^IV internal hemorrhoids with circular prolapse.Methods 144 patients with stage III^IV internal hemorrhoids with circular prolapse who were treated in our department between August 2015 and March 2017 were recruited and were assigned to two groups based on their admission number.Both groups received PPH.Patients in the control group received single-purse suture(n=76)and patients in the control group umbrella suture(n=68).Indices related to surgery,post-surgery complications and recurrence after one year were compared between the two groups.Results Blood loss during surgery was significantly less,maximum width of specimen significantly larger,and difference between maximum and minimum width of specimen significantly larger in the treatment group than in the control group(P<0.05).There was no significant difference in duration of operation and duration of hospitalization between the two groups(P>0.05).Incidence of incomplete retraction of hemorrhoids was significantly lower in the treatment group(P<0.05).There was no significant difference between the two groups in postoperative anastomotic bleeding and pain(P>0.05).One-year recurrence rate did not differ between the two groups(P>0.05).Conclusion Compared with single-purse suture,umbrella suture during PPH has less intraoperative blood loss,larger width of specimen,larger difference between maximum and minimum width of specimen,and fewer postoperative incomplete retraction of hemorrhoids.

关 键 词：环状脱垂内痔 吻合器痔上黏膜环切钉合术 伞形缝合法 单荷包两点牵引法 

分 类 号：R657.1[医药卫生—外科学]