吻合口位置高低与痔上黏膜环钉合术手术效果分析

Analysis of the relationship between stoma position and postoperative effects of procedure for prolapse and hemorrhoids in the treatment of hemorrhoids

目的探讨痔上黏膜环钉合术(PPH)的吻合口距齿线的距离对手术效果的影响.方法采用33 mm痔上黏膜环形切除吻合器治疗脱垂性痔401例.其中Ⅱ度内痔45例,Ⅲ～Ⅳ度痔356例.吻合口在齿状线上1 cm内219例、1～2 cm 87例、2～3 cm 60例、3～4 cm 25例、4 cm以上10例.测量手术吻合口的部位,并将数据与手术治疗的效果进行分析.结果术中选择吻合口距齿线1～2 cm者,术后发生脱垂率低(1.1%,1/87),吻合口距齿线4 cm以上,术后发生脱垂率较高(6/10)(χ2=102.2, P<0.01).结论吻合口的部位与手术效果有明显的关系,吻合口在齿线2 cm以内效果最好.

Objective To explore the relationship between stoma position and postoperative effects of procedure for prolapse and hemorrhoids （PPH） in the treatment of hemorrhoids. Methods Four hundred and one hemorrhoid patients were treated with circular stapler. Ⅱ hemorrhoids, 45 cases;Ⅲ- Ⅳ hemorrhoids, 356 cases. The position of stoma located 1cm up dentate line, 219 cases; 1-2 cm up dentate line, 87 cases; 2-3 cm up dentate line, 60 cases; 3-4 cm up dentate line, 25 cases; 〉4 cm up dentate line, l0 cases. The patients were followed from one week to two years postoperatively. Results Postoperative effects and procidentia rates have significant association with the position of stoma. If the distance between position of stoma and dentate line is ≤2 cm, the postoperative procidentia rate was 1.1%, lower than that of the distance≥ 4 cm. Conclusions The complication and procidentia rate of PPH is associated with the stoma position. The stoma position should be no more than 2 cm to dentate line.