结扎速血管闭合系统在Ⅲ、Ⅳ度痔切除术中的应用

Preliminary application of LigaSure vessel sealant system in hemorrhoidectomy for patients with Grade 3 and Grade 4 hemorrhoids

目的探讨结扎速血管闭合系统(Liga Sure)在Ⅲ、Ⅳ度痔切除术中的应用价值。方法65例Ⅲ、Ⅳ度痔患者,其中男41例、女24例,在局麻下实施LigaSure痔切除术。观察手术时间、术中及术后出血量、术后疼痛和并发症情况。结果65例手术均获得成功。手术时间为5～25min(9.7±4.6min)。术后疼痛评分:术后4h为1～7(3.7±1.7),术后24h为0～5(1.9±1.3)。术后3天除4例评分在3～5以外,其他患者评分均在3以下。术后7天有5人评分为1～3,余患者均无疼痛主诉。术后2个月时所有患者均无疼痛主诉。9例(15.8%)患者术中出血量小于15ml,其余56例(86.2%)术中无明显出血。术后有1例因出血给予再处理,18例(27.7%)仅表现为少量血性渗出。术后6例出现短期排便轻度失禁,无严重并发症发生。结论LigaSure用于痔切除术止血效果良好,手术时间短,患者术后疼痛轻。

Objective To evaluate the use of LigaSure vessel sealant system on hemorrhoidectomy for the patients with grade 3 and grade 4 hemorrhoids. Methods Sixty five patients with hemorrhoids （41 males and 24 females）, among whom 46 cases were grade 3 and 19 cases were grade 4, tmderwent hemorrhoidectomy under local anesthesia with the use of LigaSure vessel sealant system. The time consumed for operation and the blood volume lost during and after operation were recorded. Postoperative pain was assessed by means of visual analog score （1-10）. The patients were followed up for 2 months. Results The operations were performed successfully in all patients. The time consumed was 5-25 minutes （9. 7±4.6 minutes）. The pain scores at 4 hours and 24 hours after operation were 1-7 （2. 7±1.7） and 0-5 （1.9±1.3）, respectively. On the third day after operation, only 4 cases had a pain score of 3 to 5, in the remaining 61 cases the score was under 3. On the seventh day after operation, only 5 patients had pain scores of 1 to 3. No patients complained pain about 2 months later. The volume of blood loss in 9 cases was less than 15rnl （15. 8%）, and in the remaining 56 cases there was no apparent blood loss during the operation. Only one patient was re-operated for bleeding after operation, and in 18 （27. 7%） patients there was only oozing of blood. Mild incontinence occurred in 6 patients shortly after operation, and no severe complications occurred. Conclusions LigaSure vessel sealant system shows the advantage of good haemostatic effect, less time consuming for operation, and less pain after operation for the treatment of patients with Grade 3 and Grade 4 hemorrhoids.