直肠黏膜环切吻合肛垫悬吊治疗重度痔

Treatment of prolapsed hemorrhoids with circular stapler

目的 探讨使用吻合器行直肠痔上黏膜环切吻合肛垫悬吊术 (PPH)的效果和可行性。方法 使用PPH吻合器治疗Ⅲ～Ⅳ度痔 74例 ,其中男 2 7例 ,女 4 7例 ,平均年龄 5 7岁 (31～ 80岁 ) ,平均发病时间 7 3年 ,最长 30年。 结果 72例患者术后 2～ 3d脱出痔完全回缩 ,2例患者因术中行肛门息肉切除 ,术后出现疼痛和肛门水肿 ,1周后水肿消失疼痛好转。 3例患者发生术中和术后出血 ,其中 1例痔急性水肿期术后出血 ,2例因吻合器故障出现吻合和切割不全 ,出血较多约 30 0ml,手术时间延长至 1h。 70例患者手术时间约为 10～ 15min。除 2例患者住院时间超过 1周外 ,大多患者住院时间为 2～ 4d。 结论 PPH技术治疗Ⅲ～Ⅳ度痔效果好安全可靠 ,手术和住院时间短 ,术后基本无疼痛。

Objective To evaluate the efficacy and safety of circumferential mucosectomy procedure for treatment of prolapsed hemorrhoids(PPH). Methods From June 2001 to June 2003, 74 patients(27 men and 47 women) with an average age of 57 years(ranging from 31 to 80 years), with prolapsed hemorrhoids Ⅲ～Ⅳ degree underwent PPH using a circular stapler. Results 69(93.2%)patients were fully satisfied with results. Two patients underwent simultaneous rectal polypectomy along with PPH hence required analgesic treatment for 5 days. Three patients experienced bleeding during or after operation, 1 case bleeding was due to ulcerative hemorrhoid, while the bleeding the remaining 2 cases was (bleeding about 300 ml)caused by insufficient anastomosis, thus extending operating time to 1 hour. The average operation time (70 patients) was 13 minutes(range 10～15 minutes). The mean hospitalization was 3.5 days(2～4 days), with exception of 2 patients lasting 1 week. Conclusion PPH is a safe, effective and rapid method for treatment of prolapsed hemorrhoids, The procedure causes minimal pain with decreased complications.