吻合器痔上粘膜环切术术后并发症的处理对策

Managed strategy of postoperative complications of procedure for prolapse and hemorrhoids

目的探讨吻合器痔上粘膜环切术(PPH)治疗中重度痔病术后并发症的原因及处理对策。方法对我科自2001年5月至2004年6月100例Ⅲ°～Ⅳ°痔病行PPH的临床资料进行回顾性分析。结果本组手术时间平均是20.5min,术后1～3天出院,平均住院时间为4.5天。20例术中在吻合切除完成后再检查须缝合止血。术后外脱的痔块回缩率为100%,其中完全回缩是62%。术后肛门疼痛须用止痛剂35例,轻度大便失禁20例,肛周感染3例。术后未发现吻合狭窄、直肠阴道瘘及须再手术止血的病例。结论PPH的优点是手术比较安全,疗效好,手术时间短,术后恢复快和疼痛少、减少PPH术后并发症的重要措施是在正确的手术操作平面为距齿状线上4～5cm的直肠粘膜。荷色缝合技术造影响手术疗效的关键。

Objective To investigate the cause and managed strutegy of postoperative complications of procedure for prolapse and hemorrhoids(PPH)in the treatment of maderate and severe hemorrhoids. Methods From May 2001 to June 2004,100 cases with Ⅲ°～Ⅳ° hemorrhoids received PPH were analyzed retrospectively.Results Mean operative time was 20.5min.The patients were discharged from hospital in 1～3days after operation.Mean hospitalization time was 4.5days.20 cases were need to suture hemostasis during the end of PPH and re-examination.Postoperative hemorrhoidal lump retraction rate was 100% and among them,complete retraction rate was 62%.Analgetic was given for anal pain in 35 cases after operation.Mild fecal incontinence was in 20 cases.Peri-anal infection was in 3 cases.No anastomotic stenosis,rectovaginal fistula and re-operative hemostatic case were found after operation.Conclusions PPH has many advantages,including its safety,a good effectiveness,rapid recovery and less pain after operation.For reducing postoperative complications,it is very important to take a suitable plane of operative manipulution on the rectal mucosa above dentate line 4 to 5 cm.A right technique of purse-string suture is successful keys to influence the operative efficacy.