吻合器痔上粘膜环切术(PPH)治疗痔506例临床研究.doc

吻合器痔上粘膜环切术(PPH)治疗痔506例临床研究【摘要】 目的:探讨和分析吻合器，程序和痔疮(PPH)。方法:对临床治疗第三或者第四度痔疮的资料分析。结果:全部患者手术切除的506例 PPH,除2例失败,其他一切都是成功的。发现81例不同程度的出血,并且都缝扎止血成功。平均术后住院日数为3天(2 ~ 4天)。所有这些病例,502例痔疮有绝对的回缩,4例没有。结论:所建立的程序和痔疮(PPH)是安全、有效、快速的治疗痔的方法，细节的操作对手术结果有很大的影响 【关键词】 混合痔吻合器;程序和痔疮 Treatment of Circular Mixed Hemorrhoids with the Procedure for Prolapase and Hemorrhoids:Analysis of 506 Cases The Coloproctological Surgery of the Hiser Hospital Affiliated to Qingdao University,Qingdao,Shandong 266033 【Abstract】 Objective: To evaluate and analyze the technique of procedure for prolapase and hemorrhoids(PPH). Methods: Analyzing the clinical data of the third or fourth degree hemorrhoids operated by procedure for prolapase and hemorrhoids. Results: Total 506 patients were operated on by PPH, Except for 2 case that was failed, all the others are succeed. 81cases were found with pulsatile blood of different extent ,and were all stanched by crossing stitching. The mean postoperative hospital stay were three days(2~4days) . Through all the cases, 502 cases have absolute retraction, and 4cases don”t have . Conclusion: The procedure for prolapase and hemorrhoids(PPH) was safe,effective and rapid way to cure hemorrhoid . And the operating details have great affect on the results of operation. 【Key words】 Mixed hemorrhoid; Procedure for prolapase and hemorrhoids 1998年Longo提出吻合器痔上粘膜环切术(procedure for prolapse and hemorrhoids,PPH)治疗痔病，由于疗效理想而迅速得到推广。2000年6月PPH由新加坡学者肖俊介绍到上海，在国内得到迅速而广泛的推广和开展，至今手术例数已超过数万例。国内对PPH的命名各不相同：如称PPH，Longo术，吻合器痔切除术，痔上粘膜吻合器环形切除术，直肠下端环形粘膜及粘膜下层切除，肛垫悬吊术等。有学者认为从本质上讲，称PPH为吻合器痔上粘膜环切术较为贴切。自2002年1月至2007年12月我院完成吻合器痔上粘膜环切术（即PPH术）治疗痔506例，不仅减少了手术的疼痛，缩短手术的时间和住院时间，手术并发症少，效果良好，深受广大患者的欢迎，现总结如下。 1 临床资料 1.1 临床资料： 本组506例，其中男257例，女249例，年龄：25―76岁，平均56.5岁。病史1年―40年。Ⅱ期内痔57例，Ⅲ期内痔311例，Ⅳ期内痔65例，混合痔73例。主要症状为肛门脱出，其中378例为环状脱出，263例肛缘有皮赘，合并症：直肠中下段息肉33例，直肠粘膜内脱垂67例。直肠前突115例。 1.2 治疗方法 1.2.1 术前准备：备皮及助便 1.2.2 麻醉：硬膜外麻醉 骶麻 1.2.3 体位：膀胱截石位 1.2.4 器械：2002－2003年采用强生PPH01型环切吻合器172例 ，采用美国强生公司痔疮环状切除