吻合器痔上黏膜环形切除术对直肠上动脉血流影响的临床研究

Influence of the procedure for prolapse and hemorrhoids on the blood flow of the superior rectal artery

目的 探讨吻合器痔上黏膜环形切除术(PPH)对直肠上动脉供血的影响。方法 对10例Ⅲ、Ⅳ度痔患者,在行PPH手术前、后用直肠腔内彩色多普勒超声测量其直肠上动脉分支血流速度的变化;同时用肛门镜检查痔核大小及出血情况。术中检查吻合口有无出血,并切除标本行病理检查。结果 全组患者术后痔核明显缩小,出血停止。10例患者中,4例直肠上动脉分支位于黏膜下2mm以内的患者手术后1个月复查,其血流基本消失;6例直肠上动脉分支位于黏膜下2～4mm之间的患者血流速度无明显变化。病理检查标本未见肌肉及痔组织,4例直肠上动脉分支位于黏膜下2mm内的患者近直肠切缘有血管,而位于2～4mm之间的6例患者近直肠切缘无血管。结论 PPH手术对位于黏膜下2mm以内的直肠上动脉分支可起到阻断作用,而对超过黏膜下2mm的直肠上动脉分支无作用。PPH手术并不完全依靠阻断痔的动脉血流而起效。

Objective To explore the influence of the procedure for prolapse and hemorrhoids (PPH) on the blood flow of the superior rectal arterial. Methods The blood flow velocity of the superior rectal arterial branches was measured by colored proctoscopic doppler uhrasenography before and after PPH in 10 cases with Ⅲ and Ⅳ degree hemorrhoids. The anoscopy was used to inspect the hemorrhoids node size and hemorrhage. The anastomosis was inspected to detect the bleeding spot. The histological examination was carried out on the resected specimens. Results In all the ten patients, the hemorrhoids node size decreased after operation and the bleeding stopped. The blood flow of the superior rectal arterial branches less than 2 mm beneath the mucosa in four patients disappeared after operation, while those more than 2 mm beneath the mucosa in the other 6 patients still existed. The histological examination of the resected specimens revealed no muscle and hemorrhoids tissue. There were blood vessels on the rectal margin of the specimens in the four patients with superior rectal arterial branches less than 2mm beneath the mucosa, while no vessels in the other 6 patients with such branches more than 2 mm beneath the mucosa. Conclusions PPH operation can block the superior rectal arterial branches less than 2 mm beneath mucosa, can not influence those superior rectal arterial branches more than 2 mm beneath the mucosa. The operative outcomes of PPH are not only dependent on the complete interruption of the arterial inflow of the hemorrhoids.