痔术后出血136例临床分析

Clinical Analysis on Postoperative Bleeding of 136 Patients with Hemorrhoids

为探讨痔术后出血的原因和预防处理措施,回顾性分析行痔切除术后出血的136例患者临床资料。结果显示,原发性出血18例,继发性出血118例。其中外剥内扎术后出血33例(24.3%),PPH术后出血46例(33.8%),外剥内扎联合PPH术后出血57例(41.9%)。原发性出血原因均为术中操作不当、止血不彻底,继发性出血原因依次为PPH吻合口出血、痔核结扎部位出血及术后感染。此次分析结果提示局部压迫、手术缝扎止血、电凝止血是止血的有效措施,可根据手术方式、出血部位、出血程度选择合适的止血方法。术前评估出血风险,术中规范操作,彻底止血,术后预防感染加强管理是预防痔术后出血的重要措施。

In order to explore the cause of hemorrhoids patient＇s postoperative bleeding, as well as relevant prevention 8〉 management measures,authors retrospectively analysed the clinical data of 136 patients who had received surgery and then suffered from bleeding.As results, among 136 cases, 18 suffered from prima- ry bleeding,118 from secondary bleeding including 33 being bleeding after M-M procedure（accounted for 24.3%） ,46 after PPH（33.8%）,57 after M-M combined with PPH（41.9%）;primary bleeding was due to improper manipulation, and incomplete stopping bleeding; secondary bleeding was sequently due to PPH stoma bleeding,bleeding of the ligation site for hemorrhoids core and postoperative infection. Above-men- tioned analyzed results show that locally pressuring,operative suturing to stop bleeding,and electrocautery for stopping bleeding are the effective measures for stopping bleeding which are chosen according to the procedure, bleeding site and bleeding situation fittingly, and preoperatively evaluating bleeding risk, intrao- peratively normal manipulation and complete stopping bleeding, and postoperatively preventing infection and strengthen management are important measures to avoid bleeding.