吻合器痔上黏膜钉合术治疗重度痔疮226例

Effects of procedure for prolapse and haemorrhoids on severe hemorrhoids: a report of 226 cases

目的:探讨吻合器痔上黏膜钉合术(PPH)治疗重度痔疮的临床疗效. 方法:对226例Ⅲ,Ⅳ度痔疮患者行PPH术,比较患者术前,术后1,6,30 d和随访终点的疼痛、出血、坠胀和水肿情况. 结果:226例患者的平均手术时间为9 min;术后1d疼痛的发生率为20_5%、出血的发生率为5.7%;至术后30d疼痛、出血情况明显改善;术后46.9±10.8h出现首次排便;平均住院天数为4.4±1.2d;恢复正常工作的平均时间8.0±1.7d;术后并发症发生率低,以尿潴留(10%)和出血(5.7%) 多见,但少见的并发症(感染、吻合口狭窄、腰背部酸痛等)也需引起重视;有2例严重的痔疮患者先后作了2次PPH 术,术后恢复良好;随访了186例患者,平均随访时间为22.4±7.4mo,随访率为89.6%(186/208),仅有4.5% 的患者表现为少量的出血,其余均恢复良好,无复发. 结论:吻合器痔上黏膜钉合术具有手术时间短,创伤小, 恢复快,并发症少等优点。

AIM: To assess the clinical value of procedure for prolapse and haemorrhoids (PPH). METHODS: A total of 226 Ⅲ-and Ⅳ-degree haemorrhoids were treated with PPH. The pain, bleeding, prolapse and edema in annal, before the procedure,1, 6 and 30 days after the procedure, and in the end of the follow-up were analyzed. RESULTS: Of the 226 patients, the mean operation time was 9 min. In the next day after the procedure, the pain rate was 20.5% and the bleeding rate was 5.7%, but 30 days later, pain and bleeding were cured. All the patients had the first stool 46.9+10.9 h after the procedure and the mean hospital time was 4.4±1.2 d. 8.0±1.7 d after the procedure, most of the patients came to the work. Retention of urine (10%) and bleeding (5.7%) were the main complications. The unusual complications included infection, stenosis and back ache. There were 2 severe patients who had twice of procedure. In 186 patients followed-up (89.6%), 4.5% had a little bleeding. The mean follow-up time was 22.4+7.4 mo. CONCLUSION: PPH is effective, safe, and minimal invasive, and it is the first choice to deal with severe haemorrhoids.