“直视两针法”技术在PPH手术中的临床对照研究

The clinical study of comparison direct-vision and two stiches method in PPH surgery

目的:通过前瞻性随机对照研究,探讨"直视两针法"等技术改进对PPH手术操作过程及效果的影响。方法:将我科行PPH术的683例病例随机分为两组,观察组术中进行"直视两针法"等技术改进,对照组按照标准手术操作流程操作,比较两组手术时间、术中出血量、术后标本宽度、术后并发症等。结果:观察组350例,手术时间平均(12.2±4.0)min,术中出血量(4.95±2.82)m L,标本宽度(2.61±0.32)cm,术后出血行止血手术2例,术后痔区水肿或血栓5例;对照组333例,手术时间平均(17.2±3.6)min,术中出血量(7.55±3.94)m L,标本宽度(1.18±0.56)cm,术后出血行止血手术5例,术后痔区水肿或血栓14例,术后感染1例,直肠狭窄1例,直肠阴道瘘1例。观察组手术时间较短,切除宽度、深度适宜,术后严重并发症少见。结论:"直视两针法"等技术改进,降低手术操作难度,简便、安全、有效。

Objective To evaluate the effect of ＂direct-vision and two stiches method＂ and other techno- logical improvements on PPH surgical operation by prospective randomized controlled study. Methods A total of 683 patients were randomly assigned. Direct-vision and two stiches method technological improvements were applied in observation group, while standard operation procedures were performed in control group. Operation time, blood loss during operation, specimen size, post-operative complication and other conditions were compared between observation group and control group. Results In 350 cases of the observation group, the average surgical time was （12.2±4.0）minutes, blood loss during operation （4.95±2.82）mL and specimens width （2.61±0.32）cm. 2 patients with hemorrhage were performed hemostasis after surgery. 5 cases suffered from edema or thrombus in haemorrhoids zones after surgery. In 333 cases of the control group, the average surgical time was （17.2 ±3.6）minutes, blood loss during operation （7.55± 3.94）mL and specimens width （1.18±0.56）cm. 5 patients were performed hemostasis after surgery, 14 cases suffering from edema or thrombus in haemorrhoids zones after surgery, postoperative infection in 1 case, rectostenosis in 1 case, and 1 case in rectovaginal fistula. In the observation group, operation time was shorter than that in the control group. No significance was found in excision width and depth. The serious complications after surgery are fewer in observation group than that in the control group. Conclusion The ＂direct-vision and two stiches method＂ and other technological improvements are safe and effective, meanwhile operation difficulty can be reduced.