吻合器痔上黏膜环形切除钉合术(PPH)治疗痔的经验总结(附576例总结报告)

Experience summary of procedure for prolapse and hemorrhoids in 576 cases of hemorrhoids

目的探讨吻合器痔上黏膜环形切除钉合术（PPH）疗效影响因素，提高PPH手术质量。方法回顾性总结576例患者的PPH手术资料，分析其疗效影响因素。结果手术时间平均23．5min，平均住院时间3．5d，切除痔上黏膜宽度平均约2．5cm。93．5％术中痔核回缩满意，因大面积钉合不全及切割不全各1例发生术中大出血，尿潴留184例（31．9％），肛门疼痛357例（62％），3例术后大出血再次行手术止血。484例（84％）随诊1～4年，术后症状改善满意者94．3％，2例误诊，4例因血栓外痔行血栓外痔切除术，其余患者均无复发，无肛门狭窄、大便失禁。结论术前、术中、术后充分认识PPH疗效影响因素，可进一步提高PPH质量。

Objective To investigate the factors which influence the curative effect of procedure for prolapse and hemorrhoids （PPH）. Methods The operative data of 576 patients with hemorrhoids underwent PPH were retrospectively studied. Results The average operation time was 23.5min. The average hospital stay was 3.5d. The correction of the prolapsed hemorrhoids was satisfied in 93.5% patients. Intraoperative hemorrhea occurred in two cases because the large range rectum mucosa was uncompletely stapled or cut. Urine retention occurred in 184 cases （31.9%）, anal pain in 357 cases （62%） and a second operation were performed in 3 cases because of postoperative hemorrhea. A total of 484 cases were followed-up for 1-4 years. The postoperative satisfaction rate of symptom improvement was 94.3%. Four cases underwent thrombosed external hemorrhoid resection. Other patients had no recurrence, no anal stenosis and no fecal incontinence. Conclusion Adequate and full understanding of the effect-influencing factors before, during and after operation can improve the qualities of PPH.