RPH治疗直肠粘膜内脱垂离体试验和临床应用

An Invitro Test and Clinical Application of RPH for Rectal Intramucosal Prolapse

目的研究自动弹力线痔套扎吻合器套扎离体人直肠标本,探索自动痔套扎术(RPH)治疗直肠粘膜内脱垂的基本参数及其临床应用的可行性与安全性。方法观察RPH套扎10例离体人直肠手术标本,分析套扎点数、吸引压力、操作方式与肠粘膜紧缩效果、吸入肌层的关系;依据试验结果,对28例直肠粘膜内脱垂患者行RPH治疗。结果离体人直肠壶腹部自然展开周径为6. 8～8. 5 cm,平均(7. 6±1. 2) cm;最大展平周径10. 5～12. 0 cm,平均(11. 6±1. 1) cm。单点套扎吸入粘膜直径1. 8～2. 8 cm,平均(2. 3±0. 4) cm,多点套扎后粘膜明显紧缩。套扎远端直肠粘膜时,通过抖动套扎器无肌层被吸入,持续吸引有浅层肌肉被吸入;套扎近端直肠粘膜,抖动套扎器无肌层被吸入,持续吸引则肠壁全层被吸入。28例患者中治愈25例,治愈率为89. 3%。术后下腹部及肛门坠胀不适26例,肛门疼痛6例,肛门少量出血2例,经对症处理1周后均缓解,无创面感染、大出血、肠穿孔、直肠阴道瘘等严重并发症发生。随访6～23个月,3例仍有排便不尽感,但较术前明显改善,排便造影亦显示粘膜脱垂减少1/3以上,无一例复发。结论 RPH治疗直肠粘膜内脱垂手术操作简单,安全可行,效果满意。

Objective To study the invitro test of ruiyun procedure for hemorrhoid( RPH) and to explore the feasibility and safety of RPH in the treatment of rectal intramucosal prolapsed. Methods The numbers of ligation points,suction pressure,operative mode and intestinal mucosa tightening effect and inhaled muscle layer were observed in 10 cases of human rectal operation specimens by RPH in vitro. 28 cases of internal rectal mucosa prolapse were treated with RPH. Results The natural expansion circumference of the ampulla of human rectum in vitro was 6. 8 to 8. 5 cm with an average of( 7. 6 ± 1. 2) cm,and the maximum flattening circumference was 10. 5 to 12. 0 cm with an average of( 11. 6 ± 1. 1) cm. During the ligation of distal rectum mucosa,there was no muscle layer was inhaled by shaking the ligation device,but few superficial muscles was inhaled by continuous suction; During the ligation of proximal rectal mucosa,no muscle layer was sucked by trembling the ligation device,while the whole intestinal wall was sucked by continuous suction. Out of 28 patients,25 were cured and the cure rate was 89. 3%. Lower abdominal and anal swelling discomfort was found in 26 cases,anal pain in 6 cases and minor anal hemorrhage in 2 cases. After symptomatic treatment for one week,all patients were relieved. No serious complications such as wound infection,massive hemorrhage,intestinal perforation and rectovaginal fistula occurred. During the follow-up period of 6 to 23 months,incomplete defecation appeared in 3 cases,but improved significantly than that before the operation. Defecation angiography showed that mucosal prolapse was reduced by more than 1/3 without recurrence. Conclusion The operation of RPH is a simple,safe and feasible procedure for rectal intramucosal prolapse.