吻合器痔上粘膜环切术对肛肠动力学影响的临床研究

Comparison of influence on anorectal dynamics about hemorrhoids by PPH and Milligan-morgen operation

目的:比较吻合器痔上粘膜环切术(PPH手术)与传统痔外剥内扎术对肛门直肠动力学影响的差异。方法:采用瑞典生产的肛肠测压仪测量PPH术和传统常规手术术前及术后3月患者的肛管静息压(RASP)、肛管收缩压(MASP)、直肠感知阈值(RSTV)、直肠最大容量阈值(RMTV)的变化,切除标本送病理检查,观察有无肌肉组织和痔组织。结果:PPH术后肛管RASP较术前明显降低(P<0.01),肛管MASP、直肠RSTV、直肠RMTV较术前有轻微降低但无显著性差异(P>0.05),肛管RASP在PPH手术组恢复至正常水平,而在传统手术组肛管MASP、直肠RSTV、直肠RMTV较术前和正常值均有显著性降低。病理检查切除标本中无肌肉组织,仅含少量痔组织。结论:PPH手术使重度痔患者的肛管高压明显改变,使肛垫得到保护,而对直肠功能影响较小,使直肠功能得到最大保护。

Objective：To compare the influence on anorectal dynamics about severe hemorrhoids between the PPH and traditional Milligan - morgen operation. Methods： Resting anM sphincter pressure （ RASP ）, maximal anal sphincter pressure （MASP）, rectal sensM threshold volume （RSTV） and rectal maximal tolerable threshold volume （RMTV） was measured by anorectal pressure instrument which made in Sweden before and after the PPH or traditional Milligan - morgen operation. The resected specimen were examined histologically. Results： After PPH operation, The RASP decreased obviously（ P 〈 0. 01 ）, there was a slight but no significant decrease in MASP, RSTV, RMTV（ P 〉 0. 05 ）, the MASP reversed to normal values after PPH operation. At the same time, there was a significant decrease in RASP, MASP, RSTV, RMTV after traditional Milligan - morgen operation（ P 〈 0. 05 ）. The histological examination showed that there was no muscle and little hemorrhoids tissue in 3 specimens after PPH hut much hemorrhoids tissue in all specimens after Milligan - morgen operation. Conclusion： PPH operation changes the high anal pressure and protected anal cushion, so the anorectal function can be protected perfectly after the PPH operation.