反复使用型肛痔吻合器行痔上黏膜环切术的手术配合

Experiences of operative cooperation of domestic reusable stapler in procedure for prolapse and hemorrhoid

目的:总结应用国产反复使用型肛痔吻合器行痔上黏膜环切术的手术配合经验。方法:回顾性分析796例采用国产反复使用型肛痔吻合器行痔上黏膜环切术的临床资料。术中采取积极的护理配合措施。结果:796例手术均获得成功,手术时间(23.5±3.8)m in,切除痔上黏膜宽度平均为(2.5±0.6)cm,切除直肠黏膜环完整者95%,93.5%术中痔核回缩满意。因吻合器机械故障不能击发2例,垫圈装反造成切割不全1例,吻合钉质量欠佳造成大面积钉合不全5例,由于吻合器未关闭保险钮致缝钉过早顶出2例。共随访到677例患者(85.1%),中位随访时间为47个月。术后症状改善满意者93.1%(741/796),无肛门狭窄及大便失禁及围手术期死亡病例。结论:应用国产反复使用型肛痔吻合器行痔上黏膜环切术是安全可行的,掌握国产肛痔吻合器的组装及操作规程,熟练的手术配合是手术顺利进行的保证。

Objective：To summarize the experiences of the operative cooperation of domestic reusable stapler in procedure for prolapse and hemorrhoid（PPH）.Methods： The operative date of 796 patients underwent PPH used domestic reusable stapler were retrospectively studied.Allthe patients were given nursing cooperation during in operation.Results： The operation of 796 cases were successfully performed.The average operation time was（23.5±3.8） min.The average width of excised mucosal ring was（2.5±0.6） cm.The excised mucosal ring was complete in 95%.The correction of the prolapsed hemorrhoids was satisfied in 93.5% patients.The stapler can＇t be fired because mechanicalfailure in 2 cases.The rectum mucosa was incompletely cut in 1 case because the gasket was reversed.The large range rectum mucosa was incompletely stapled in 5 cases because poor quality of the staple nail.The staple nail was pushed out earlier in 2 cases because stop button of the stapler wasn＇t closed.677 cases（85.1%） were follow-up.The median time of follow-up was 47 months（range： 9-79 momths）.The postoperative satisfaction rate of symptom improvement was 93.1%（741/796）.There was no anal stenosis,fecal incontinence and perioperative death.Conclusion： Domestic reusable stapler could be safely applied to PPH.It was important guarantee to master assembling the domestic reusable stapler and operating rules,proficient operative cooperation for the success of surgery.