保留直肠后壁黏膜的吻合器痔上黏膜环切钉合术临床疗效分析

Efficacy of retained rectal posterior mucosa in procedure for prolapse and hemorrhoids

目的：探讨行吻合器痔上黏膜环切钉合术（PPH）患者保留直肠后壁黏膜的临床疗效及必要性。方法回顾性分析2010年1月至2012年5月温州医科大学附属第二医院肛肠科连续收治的260例Ⅲ或Ⅳ度内痔以及环状混合痔患者的临床资料。术前肛门镜检查发现截石位6点区域无明显内痔核的患者选择行保留直肠后壁黏膜PPH （改良组，132例）；其余患者采用常规PPH （常规组，128例）。比较两组的术中及术后情况。结果两组患者均顺利完成手术。与常规组比较，改良组疼痛持续时间[（1．3±0．5） d比（4．8±0．7） d]、应用镇痛药频率[（1．1±0．3）次比（5．9±0．6）次]及住院时间[（5．2±0．8） d比（5．8±0．5） d]明显减少，吻合口狭窄（0比7．8％）、肛门坠胀感（0．8％比14．1％）及迟发性出血（0比7．8％）的发生率亦明显降低（均P＜0．01）。结论对于截石位6点区域无明显内痔核的患者选择行保留直肠后壁黏膜的PPH，可明显减少术后并发症的发生。但长期效果还需进一步观察。

Objective To evaluate the efficacy and necessity of retained rectal posterior mucosa in procedure for prolapse and hemorrhoids （PPH）. Methods Clinical data of 260 cases with severe hemorrhoids in our hospital from January 2010 to May 2012 were analyzed retrospectively. A total of 132 cases with severe hemorrhoids excluding in rectal posterior wall were enrolled in retained rectal posterior mucosa in PPH （improvement group）, other 128 cases of severe hemorrhoids were assigned to PPH （conventional group）. Operative parameters, efficacy and complication after operation were compared. Results Two groups of patients received successful operations. Postoperative pain duration , frequency of analgesic drugs and postoperative hospital stay in improvement group were significantly reduced [（1.3±0.5） d vs. （4.8±0.7） d, 1.1±0.3 vs. 5.9±0.6, （5.2±0.8） d vs. （5.8±0.5） d, all P〈0.01]. Incidence of anastomotic stenosis, heavy feeling in the anus and delayed bleeding in improvement group were significantly lower than those in conventional group （0 vs. 7.8%, 0.8% vs. 14.1%, 0 vs.7.8%, all P〈0.01）. Conclusions The application of retained rectal posterior mucosa in PPH to patients with severe hemorrhoids excluding in rectal posterior wall can significantly reduce postoperative complications. But long-term efficacy needs further observation.