PPH术中采用常规缝扎动脉搏动部位防止术后早期出血临床意义.doc

PPH术中采用常规缝扎动脉搏动部位防止术后早期出血临床意义[摘要] 目的：探讨痔上黏膜环形切除钉合术（PPH）术中采用常规缝扎动脉搏动部位防止术后早期出血的临床意义。方法：对2006年2月～2008年10月我院收治的235例既往未曾行痔疮手术的Ⅲ、Ⅳ度内痔及反复出血的Ⅱ度内痔行PPH术，随机对其中126例患者术中常规缝扎动脉搏动部位，而未行上述操作的109例患者作为对照组，对比两者出现早期出血并发症的情况。结果：治疗组无一例出现术后早期排便滴血或因出血量大而再次手术止血，而对照组则有10例术后早期仍有排便滴血，3例因出血量大而再次手术止血。结论：PPH术中采用常规缝扎动脉搏动部位可以有效防止术后早期出血。 [关键词] PPH术；痔疮；术后并发症；治疗效果 [中图分类号] R657.18[文献标识码]A [文章编号]1673-7210（2009）03（a）-028-02 Clinical significance of suturing the artery conventionally in PPH to prevent post-operative hemorrhage XU Huan-ling, XU Wan-li, ZHAO Jing-lin (Department of General Surgery, the Central Hospital of Jiangmen, Guangdong Province, Jiangmen529000, China) [Abstract] Objective: To investigate the clinical significance of suturing theartery conventionally in PPH to prevent post-operative hemorrhage. Methods: 235 patients with Ⅲ and Ⅳ hemorrhoids and Ⅱ frequent-bleeding hemorrhoids underwent PPH from February 2006 to October 2008. The 126 patients underwent suturing the artery conventionally were compared with the other 109 patients underwent PPH without suturing the artery conventionally. The patients were selected randomly. Post-operative bleeding of cure group was compared with that of the other group. Results: No staxis or sever bleeding happened of patients in cure group. In control group, 10 patients got staxis bleeding and another 3 patients even got severe bleeding followed by the second operation. Conclusion: Suturing the artery conventionally in PPH is proved to be efficient to prevent post-operative hemorrhage. [Key words] Procedure for prolapse and hemorrhoids (PPH); Hemorrhoids; Post-operative complications; Therapeutical effect 痔是常见的外科疾病，近代观点基本支持内痔形成的“肛垫下移学说”[1]，并基于此理论提出了治疗内痔的痔上黏膜环形切除钉合术（PPH）。2000年7月，姚礼庆教授首次将PPH术引入我国[2]，因其手术时间短、手术痛苦小、住院时间短和术后恢复快[3]而得到迅速推广。我院从2002年开始开展PPH术，自2005年修订了《痔上黏膜环形切除钉合术（PPH）暂行规范》[4]（简称《规范》），我院便按照修订《规范》进行PPH术。无论是在规范手术前后，均出现术后早期出血的并发症，当然，在手术熟练及规范手术后该并发症已大大减少。部分病例因出血量大而需再次手术止血，对患者造成一定的心理压力和经济损失。2006年2月～2008年10月我院所行收治的235例Ⅲ、Ⅳ度内痔及反复出血