吻合器部分痔环切钉合联合选择性内痔缝扎术治疗环状痔的可行性和疗效

Feasibility and efficacy of stapler partial haemorrhoidectomy combined with selective suture ligation for residuary haemorrhoids in the treatment of circular hemorrhoids

目的探讨吻合器部分痔环切钉合联合选择性内痔缝扎术治疗环状痔的可行性和疗效。方法回顾性分析2016年3月至2017年8月于惠州市中心人民医院肛肠外科行吻合器部分痔环切钉合联合选择性内痔缝扎术的42例环状痔患者的病例资料。观察及随访手术情况、恢复时间、近远期并发症、疗效及肛门功能。结果患者均顺利完成手术,手术时间为(45.0±12.5)min,术后住院时间(3.2±1.4)d,术后恢复正常工作时间(12.5±5.8)d。术后疼痛明显需用止痛剂10例,肛门坠胀38例,尿潴留4例,肛缘水肿1例,肛周脓肿1例,暂时性感觉性排便失禁8例,无直肠穿孔、直肠阴道瘘、肛门大出血及盆腔感染病例。中位随访时间47个月,疼痛2例;肛乳头肥大4例;排便困难1例;无远期肛门排便失禁、无复发脱垂及反复严重出血病例。结论吻合器部分痔环切钉合联合选择性内痔缝扎术安全可行,并且疼痛轻,恢复快,中长期效果好;病理性肛垫部分环切并不会引起患者的远期肛门失禁。

Objective To investigate the feasibility and efficacy of stapler partial haemorrhoidectomy combined with selective suture ligation for residuary haemorrhoids in the treatment of circular hemorrhoids.Methods Clinical data of 42 patients with circular hemorrhoids who underwent stapler partial haemorrhoidectomy combined with selective suture ligation for residuary haemorrhoids at Department of Anorectal Surgery in Huizhou Municipal Central Hospital from March 2016 to August 2017 were retrospectively analyzed.Observe and follow up the operation status,recovery time,short and long-term complications,curative effect and anal function.Results The operations were successfully performed on all the patients.The operation time was(45.0±12.5)min.The postoperative hospital stay was(3.2±1.4)d and the postoperative return to normal working time was(12.5±5.8)d.There were 10 cases of obvious postoperative pain requiring analgesics,thirty-eight cases of anal bulging,four cases of urinary retention,one case of anal marginal edema,one case of perianal abscess,eight cases of transient sensory defecation incontinence,no cases of rectal perforation,rectovaginal fistula,massive anal hemorrhage and pelvic infection.The median follow-up time was 47 months,there were two cases of pain,four cases of anal papillary hypertrophy,one case of difficulty defecation,no long-term anal incontinence,no recurrence of prolapse and repeated severe bleeding.Conclusion Stapler partial haemorrhoidectomy combined with selective suture ligation for residuary haemorrhoids in the treatment of circular hemorrhoids is safe and feasible.The pain is relatively light,the recovery is quick,and the medium and long-term effects are satisfactory.Circular resection of partial pathological anal cushion will not cause long-term anal incontinence.