小“V”形切口Treitz肌保存术治疗混合痔临床疗效的病理分析

Pathological analysis of the effect of Treitz muscle preservation with small“V”incision on hemorrhoids

目的从病理解剖学方面分析小"V"型切口Treitz肌保存术治疗混合痔具有显著临床疗效的原因,为其在临床的应用及推广提供相应的病理解剖学方面的依据。方法本课题选取为2017年3月到2018年5月来我院住院治疗的低位直肠癌合并混合痔44例患者Milles术后所切除的肛门标本作为研究对象,随机分为试验组与对照组,试验组在标本组织痔核处行"小V形切口Treitz肌保存术",对照组在标本组织痔核处行传统外剥内扎术;将两组切除的肛管直肠末端组织及切除的痔核组织一并送病理活检,观察两组切除痔组织的组织层面、微血管数量(MVD)、神经纤维计数以及切除组织的肛管Treitz肌的保存情况。结果运用小V型切口treitz肌保存术治疗miles术后直肠肛管组织的混合痔,其手术所达到的组织层面HE染色、切除血管的CD34染色、神经NSE染色情况与对照组比较差异均有统计学意义(P <0.05)。结论小V型切口treitz肌保存术可以保存更多的相对正常的treitz肌、神经、血管,恢复肛垫正常形态,具有术后疼痛轻、出血少、恢复快、复发率低等优势,是一种值得在临床推广的治疗混合痔的优良新术式。

Objective From the aspect of pathoanatomy,this paper analyzes the reason why Treitz mus⁃cle preservation with small“V”incision has significant clinical effect on the treatment of mixed hemorrhoids,and provides the corresponding basis of pathoanatomy for its clinical application and promotion.Methods In this study,44 patients with low rectal cancer and mixed hemorrhoids who were hospitalized in our hospital from March 2017 to May 2018 were randomly divided into two groups:the experimental group and the control group.The exper⁃imental group underwent“small v⁃incision Treitz muscle preservation”at the hemorrhoid tissue,and the control group underwent traditional exfoliation and internal ligation at the hemorrhoid tissue.The pathological biopsy of the resected anorectal terminal and hemorrhoid tissue was performed to observe the tissue level,microvascular number(MVD),nerve fiber count and preservation of the anal Treitz muscle in the two groups.Results The results of HE staining,CD34 staining of resected blood vessel and NSE staining of nerve in the experimental group were better than the control group,with statistically significant differences(all P<0.05).Conclusion Small v⁃incision Treitz muscle preservation can preserve more normal Treitz muscles,nerves and blood vessels,and restore the normal shape of anal pad.It has the advantages of light postoperative pain,less bleeding,fast recovery and low recurrence rate.It is a new operation worthy of clinical promotion for the treatment of mixed hemorrhoids.