PPH术治疗Ⅲ、Ⅳ度痔中长期疗效研究

Curative effect of PPH for Ⅲ and Ⅳ hemorrhoids

目的:探讨吻合器痔上黏膜环切钉合术(PPH)术治疗重度痔的中长期临床疗效。方法:对采用PPH术治疗III、IV度痔146例患者术后2～5年复发情况、再次手术情况、排便功能情况、主观感受以及满意度进行随访研究。结果:实访108例,患者PPH术后2～5年痔复发脱垂者29例,复发脱垂率为26.85%。复发出血者13例,复发出血率为12.04%。术后2～5年因并发症存在不适者39例,并发症发生率为36.11%。术后再次手术者3例,再次手术率为2.78%。术后主观感受良好和较好者69例,占63.89%,满意和较满意者98例,满意率为91%。结论:PPH术治疗Ⅲ、Ⅳ度痔虽然近期疗效满意,中长期仍存在较多并发症及较高的复发率。但PPH术后并发症产生的不适症状大多轻微,需要再次手术治疗者很少,患者术后主观感受普遍良好,满意度高。PPH术仍是一种治疗Ⅲ、Ⅳ度痔的好方法。

Objective:To investigate the clinical efficacy of PPH in the treatment of severe hemorrhoids.Methods:146 patients with grade Ⅲ and Ⅳ hemorrhoids treated by PPH were enrolled in this study.The recurrence,reoperation,defecation function,subjective feeling and satisfaction were observed 2~5 years after operation.Results:There were 29 cases of recurrence and prolapse of hemorrhoids within 2~5 years after PPH,and the recurrence and prolapse rate was 26.85%in 108 cases.Recurrent bleeding occurred in 13 patients,with a recurrence rate of 12.04%.2~5 years after operation,39 cases were unfit because of complications,and the complication rate was36.11%.3 cases were reoperated after operation,and the reoperation rate was 2.78%.69 cases(63.89%)had good subjective feeling,98 cases(91%)were satisfied and satisfactory.Conclusion:Although the short-term curative effect of PPH for grade Ⅲ and Ⅳ hemorrhoids is satisfactory,there are still many complications and high recurrence rate in the medium and long term.However,most of the postoperative complications of PPH have mild symptoms,and few patients need reoperation.Postoperative subjective feeling was generally good and satisfaction was high.PPH is still a good way to treat Ⅲ and Ⅳ hemorrhoids.