吻合器痔上黏膜切除术的临床应用(附40例报告)

Clinical Application of Stapler to Treat Procedure for Prolapse and Hemorrhoids

目的 探讨吻合器痔上黏膜切除术（PPH）的临床应用及术后并发症的原因及对策。方法 对近年来所行吻合器痔上黏膜切除术（PPH）的40例Ⅲ度～Ⅳ度痔病患者的临床资料及愈后复查资料进行回顾性分析。结果 平均手术时间35min，术后住院时间2～4d，手术后脱出的痔块均回缩，切除直肠黏膜完整，术后肛门或下腹部有痛感5例，有轻度排便失禁3例（年龄均为55岁以上），肛门周围炎症1例；术后3～6个月复诊无1例复发，未发现吻合口狭窄、直肠阴道瘘，2例曾经有一过性的黏液血便。结论吻合器痔上黏膜切除术（PPH）是治疗Ⅲ度～Ⅳ度痔病的一项较新的技术，手术操作简单、安全、有效，术程短，术后恢复快，病人痛苦小，与传统术式比较有很大优势。有效减少该术式并发症的主要措施在于掌握手术操作平面的直肠黏膜与齿线的距离在4．0～5．0cm处完整的切除直肠黏膜，以及荷包缝合的技术也是影响手术成败的关键。

Objective To discuss the application of PPH and factors of complication and eountermeasure. Methods 40 cases of such Ⅲ-Ⅳ hemorrhoids patient in recent years who underwent this method were analyzed in clinical materials and follow- up materials retrospectively. Results The average operative time was 35 rain, average hospitalized time was 2 - 4 days. Tne hemorrhoid had recovery with totalrectal mucosa. There were 5 cases with lower abdominal pain and 3 eases with slight incontinence and 1 ease with perianal inflammation. There were no relapse and complication as stenosis or fistula after 3 - 6 months follow - up. 2 eases had temporary blood stool. Conclusion The PPH might he a new technique to treat Ⅲ-Ⅳ hemorrhoid with easy, simple, safe, effective, short time, soon recovery and less pain characteristics. The key point to operate of this method was the level of 4 - 5 cm to anocutaneous line with total rectal mucosa and loop suture is important as well.