痔上黏膜环形切除钉合术两种缝合方法对切除直肠黏膜宽度的影响

Effects of two suture methods on the width of resected rectal mucosa in procedure for prolapse and hemorrhoids

目的初步探讨痔上黏膜环形切除钉合术（Procedure for Prolapse and Hemorrhoids，PPH）单荷包缝合、双荷包缝合以及调节两荷包间距离对切除直肠黏膜宽度的影响，为临床医师制订个体化治疗方案及更好地开展PPH术提供依据。方法符合纳入标准的Ⅲ～Ⅳ期内痔28例，随机分为2组：单荷包缝合组15例，双荷包缝合组13例。分别对2组患者术中所切除直肠黏膜的宽度进行测量、记录。切除标本送病理检查，检查其是否带肌层。并对2组患者术后的临床疗效、并发症（出血、疼痛、尿潴留、急便感）进行统计学分析和比较。结果2组间短期临床疗效、术后并发症（出血、疼痛、尿潴留）、切除组织是否带肌层的比较，差异均无统计学意义（P〉0．05），但对2组间术中所切除黏膜环宽度进行比较发现双荷包缝合组所切除黏膜环的宽度明显大于单荷包缝合组，差异有统计学意义（P〈0．01）。结论单荷包缝合、双荷包缝合以及两荷包间距离可以控制PPH术切除黏膜环的宽度。

Objective Extrapolate the relationships between the width of circumferential rectal mucosa resected and the method of either performing single purse-string or performing double purse-string during performing the procedure for prolapse and hemorrhoids （ PPH）, and to assess the impact of both the level of staple line and the width of rectal mucosa resected on clinical outcomes after stapled hemorrhoidpexy. Methods Twenty-eight adult patients with Ⅲ-Ⅳ hemorrhoids were assigned to two groups： 15 patients using single pursestring and the remaining 13 patients using double purse-string. The mueosal width of doughtnuts of both groups were measured and the data recorded. The doughtnuts resected were sent to pathology examination after stapled hemorrhoids pexy to identify whether or not the specimens involved the smoth muscles. The demographic complications （bleeding, postoperative pain, urinary retention, fecal urgency） were compared and statistically analysed between the two groups, respectively. Results There were no statistical differences between the two groups in terms of postoperative short-term results and complication rates, as well as the proportion of involving smooth muscle in specimens （ P 〉 0.05 ）. However, when compared the width of doughtnuts resected in single-pursestring group was smaller than that in double-purse-string group （ P 〈 0. 01 ）. Conclusion The single or double-purse-string suture in PPH can control the width of resected rectal mueosa.