波浪式荷包缝合法在PPH治疗不对称性混合痔中的应用

Application of Wave-like Purse String Suture in PPH for the Asymmetric Mixed Hemorrhoids

目的探讨波浪式荷包缝合法在PPH治疗不对称性混合痔中的效果。方法76例不对称性混合痔患者均行PPH术，采用波浪式荷包缝合法，以痔核的下缘及痔核的大小作为定位依据。结果76例均一次吻合成功，平均手术时间20（10～25）min，术后平均住院3．5（2～5）d，术后3～4d脱出痔均完全回纳。术后48h内无疼痛66例（86．8％），轻度疼痛10例（13．2％），予曲马多肌注后缓解；尿潴留7例（9．2％），导尿1d后拔除；术后出血1例，经压迫止血后缓解；术后下腹胀痛或肛门下坠感12例（15．8％），经对症治疗后症状均消失。均获随访，平均18个月（3个月～3年），75例外痔核回缩，1例回缩不全，无排便失禁或肛门狭窄发生。结论PPH术中采用波浪式荷包缝合法可使脱出肛外的痔核完全回缩，术后肛周无残余外痔或皮赘，疗效可靠。

Objective To explore the effect of wave-like purse string suture applicated in PPH for the asymmetric mixed hemorrhoids. Methods 76 patients with asymmetric mixed hemorrhoids were treated with wave-like purse string suture, located by the inferior border and the size of of the hemorrhoids. Results 76 cases were successfully inosculated without repeat. The operative time was averagely 20（ 10 25 ） minutes. The postoperative hospital stay was 3.5 （2 - 5 ） days. The perianal hemorrhoids were retracted in 3 -4 days after operation. In the 48 hours after operation, 66 patients （86.8%） were indolence, and 10 patients（ 13.2% ） only felt slight pain. 7 cases（9.2% ） occurred urinary retention. 1 occurred hemorrhage and was healed by compressive hemostasis. 12 patients felt pain in lower abdomen or bearing down in the anus which were relieved by symptomatic treatment. All were followed up for 18 （ 3 - 36 ） months in average, in whom external hemorrhoids retracted completely in 75 cases while incompletely in 1 case, no encopresis or anal stenosis occurred. Conclusion Wave-like purse string suture can make the external hemorrhoids retracted completely without remnant external hemorrhoid or skin tag around the anus. So its efficacy is reliable.