国产吻合器改良PPH术治疗Ⅲ°、Ⅳ°混合痔的临床研究

Clinic Research of Stapled Hemorrhoidopexy(Modified Procedure for Prolapse and Hemorrhoids)in Treating Serious Hemorrhiodal Disease

目的观察国产吻合器改良痔上黏膜环形切除钉合术（procedureforprolapseandhemorrhoids，PPH）治疗Ⅲ。、Ⅳ。混合痔的有效性。方法采用国产吻合器经改良PPH术治疗Ⅲ°、Ⅳ°混合痔186例，分析其手术操作理论及技巧，并随机选择190例Ⅲ°、Ⅳ°混合痔患者行外剥内扎术（Milligan-Morganhemorrhoidectomy，MMH），将两组手术疗效、手术时间、术后住院时间、术后疼痛、出血、精细控便功能等进行比较观察。结果PPH组显愈率为94．0％，MMH组显愈率为92．1％，两组间差异无统计学意义（P〉0．115），两组手术时问、术后住院时间、疼痛、出血及精细控便功能下降等差异有统计学意义（P〈0．01），经改良后，PPH组切除标本上下径平均为2．5（2．3～3．5）cm，吻合口距齿状线位置平均为2．1（1．7～2．5）cm，肛垫保留及悬吊效果好。结论国产吻合器改良PPH术可有效治疗Ⅲ°、Ⅳ°混合痔，在达到手术效果同时，能更好地保留肛垫及其精细控便功能。

Objective To evaluate the effectiveness of stapled hemorrhoidopexy （modified procedure for prolapse and hemorrhoids） in the treatment of serious hemorrhiodal disease. Methods A total of 186 patients with serious hemor- rhoids undergoing modified PPH were studied. The operation theory and skills were analysed. Another 190 patients with serious hemorrhoids were randomly selected accepting Milligan-Morgan hemorrhoidectomy （MMH）. Both group were compared in terms of operation efficacy, operation time, hospitalization time after operation, postoperative pain, bleeding and fine defecation control. Results The healing rate of the PPH group and MMH group were 94.0% and 92. 1% re- spectivel.y （P〈0. 05）. There was significant difference in operation time, hospitalization time after operation, postopera tive pain, bleeding and fine defecation control between two groups （P〈0. 01）. The mean diameter of the surgical speci- mens in modified PPH group was meanly 2. 5 （2. 3-3.5） cm, the average distance between anastomotic stoma and dentate line was 2. 1 （1.7-2. 5） cm, anal cushion suspending and preservation effect was good. Conclusion The modified proce- dure for prolapse and hemorrhoids can effectively effectively treat the serious hemorrhoids, preserves anal pads and fine defecation control function better.