PPH治疗重度痔并发症分析及处理

Management of the complications associated with procedure for prolapse and hemorrhoids in treating severe hemorrhoids

目的探讨吻合器痔上黏膜环切术(PPH)治疗重度痔的并发症发生情况及处理方式。方法回顾性分析2016年8月至2018年8月揭阳市人民医院收治的210例重度痔行PPH术患者的临床资料,术后均予随访6个月,观察术后并发症发生情况以及处理效果。结果 210例患者发生术后出血5例(2.4%),1例保守治疗成功,4例需再次手术处理。术后急性肛门疼痛35例(16.7%),予追加镇痛药物处理后缓解;慢性肛门疼痛5例(2.4%),经肛门指检可扪及吻合钉残留,未予特殊处理。术后急便感26例(12.4%),4例予以复方甲硝唑溶液保留灌肠症状缓解,余22例未经特殊处理自行缓解。术后吻合口狭窄1例(0.5%),经门诊定期扩肛后好转。随访期间无复发病例。结论 PPH术治疗重度痔存在出血、疼痛、急便感、吻合口狭窄等并发症,但发生率在合理范围,正确有效的处理可获得良好效果。

Objective To investigate the occurrence of complications associated with procedure for prolapse and hemorrhoids(PPH) in treating severe hemorrhoids and management of the complications. Methods This was a retrospective analysis of 210 patients with severe hemorrhoids receiving PPH at Jieyang People’s Hospital between August 2016 and August 2018. Patients were followed up for 6 months. The complications and their management were recorded. Results Five(2.4%) patients developed postoperative hemorrhage, one was managed with conservative treatment and four required reoperation. Acute anal pain occurred in 35(16.7%) patients, all of which were managed by additional analgesics. Chronic anal pain occurred in 5(2.4%) patients, in which rectal digital examination revealed residual staple and no special management was required. Defecatory urgency occurred in 26(12.4%) patients, four of which had relieved symptoms after enema with compound metronidazole solution and 22 had relieved symptoms without special treatment. Anastomotic stenosis occurred in 1(0.5%) patient, which recovered after regular extension at out-patient clinic. No occurrence was recorded. Conclusion Common complications associated with PPH in treating severe hemorrhoids include hemorrhage, anal pain, defecatory urgency, and anastomotic stenosis. Proper management can treat these complications.