TST术中荷包缝合深度对治疗Ⅲ～Ⅳ度混合痔临床疗效的影响

The Effect on the Depth of Purse-string Suture in Tissue Selecting Technique for Mixed Hemorrhoid with Grade Ⅲ and Ⅳ

目的探讨TST术中荷包缝合深度对治疗Ⅲ~Ⅳ度混合痔临床疗效的影响。方法回顾性分析2016年3月~2017年2月采用TST术治疗的140例Ⅲ~Ⅳ度混合痔患者的临床资料,按病理结果分为两组:切除的直肠黏膜组织标本中有少量平滑肌组织者为观察组(73例),其中Ⅲ度混合痔61例,Ⅳ度12例;仅有直肠黏膜组织而无平滑肌组织者为对照组(67例),其中Ⅲ度50例,Ⅳ度17例。结果观察组术中出血量、术中吻合口活动性出血缝扎率、术后肛门坠胀、切除组织重量与体积、肛缘水肿(术后3、7、10 d)情况均优于对照组(P<0.05),而两组术后疼痛评分比较无统计学差异(P>0.05)。术后患者随访3~6月,两组均无肛门狭窄及肛门失禁等并发症发生。观察组复发3例(4.10%),对照组复发9例(13.43%),组间比较差异有统计学意义(χ2=3.875,P=0.049)。结论 TST术中荷包缝合深度达直肠壁略带肌层可减少术后并发症发生,降低远期复发率。

Objective To investigate the effect of purse-string suture depth in tissue selecting therapy stapler（TST） for the treatment of mixed hemorrhoid with grade Ⅲ and Ⅳ. Methods A total of 140 mixed hemorrhoid cases performed TST in our hospital from March 2016 to February 2017 were divided into the observation group with a slight of smooth muscle tissue（n = 73） and control group without smooth muscle tissue（n = 67）according to pathological result of excisional rectal mucous tissue. The hemorrhoids was graded Ⅲ in 61 cases andⅣ in 12 cases of the observation group,and Ⅲ in 50 cases and Ⅳ in 17 cases of the control group. Results The intra-operative bleeding volume,the intra-operative transfixion rate due to active bleeding of anastomotic stoma,the anal swelling,the weight and volume of the resected tissue and the edema of anal edge at 3-,7-and 10 days after the surgery in the observation group were better than those in the control group（P〈0.05）.There was no statistical difference in postoperative pain score between the two groups（P〈0.05）. No anal stenosis and anal incontinence was found in both groups after 3 to 6 months follow-up. The recurrence rate was 4. 10%of the observation group,and was lower than 13. 43% of the control group,and the difference was statistically between the two groups（P〈0.05）. Conclusion The depth of purse string suture to the rectal wall with slight muscle layer in TST can reduce the incidence of postoperative complications and the long-term recurrence rate.