吻合器痔上黏膜环切术诊疗体会

Experience in the diagnosis and treatment of procedure for prolapase and hemorrhoids

目的:探讨吻合器痔上黏膜环切术(PPH)并发症防治方法。方法:2015年10月-2018年6月收治行PPH患者245例,分析术后并发症原因采取治疗措施。结果:245例患者平均手术时间(13±2.5)min,尿潴留19例(7.8%)。术后24 h内需静脉或肌内注射止痛药38例(15.1%)。术中吻合口活动性出血20例(8.2%),行跨吻合口“8”字缝合止血。术中检查黏膜环不完整。术后无出血患者。肛门坠胀和水肿分别为112例(45.7%)、62例(25.3%)。无肛门狭窄、肛瘘、后腹膜气肿患者。因严重直肠黏膜内脱垂遗留痔核复位不佳者1例,门诊局麻切除痔核。其余患者疗效满意。结论:PPH荷包缝合个体化,加强盆底肌功能训练,可提高疗效,降低并发症发生率。

Objective:To investigate the prevention and treatment of complications of procedure for prolapase and hemorrhoids.Methods:245 patients treated by procedure for prolapase and hemorrhoids were selected from October 2015 to June 2018,we analyzed the postoperative complications and treatment strategy.Results:The average operation time of 245 patients was(13±2.5)min,and 19 patients(7.8%)with urinary retention.38 patients(15.1%)needed intravenous or intramuscular injection of analgesics 24 hours after operation.During the operation,20 cases(8.2%)of anastomotic active bleeding were treated by cross anastomotic"8"suture to stop bleeding.The mucosal ring was not complete,patients without bleeding after surgery.112 cases(45.7%)and 62 cases(25.3%)had anal distention and edema respectively.No patients with anal stenosis,anal fistula,posterior peritoneal emphysema.Due to severe rectal mucosal prolapse,the residual nucleus was poorly removed in one case,and the pericardial nucleus was removed from the clinic.The other patients were satisfied with the results.Conclusion:PPH purse suture individualization and strengthen pelvic floor muscle function training can improve the curative effect and reduce the incidence of complications.