PPH手术荷包缝合技术临床探析.docVIP

PPH手术荷包缝合技术临床探析 　 作者：廖健南 邱磊 谢沛标 周爱华 廖一 【摘要】 目的 探讨适合PPH手术的荷包缝合技术。方法 对183例Ⅲ、Ⅳ度环状脱垂性内痔行PPH术，比较分析手术时间、术中下腹部疼痛、切除直肠黏膜宽度、吻合口部位、术中出血、痔核回缩、术后肛门疼痛、术后出血及住院时间。结果 对于Ⅲ度痔，改进荷包缝合后切除直肠黏膜宽度、完整度、痔核回缩明显优于改进前（Plt;0.05），手术时间、术中下腹疼痛、术中出血、术后疼痛、术后出血、住院时间无显著性差异（P＞0.05）；对于Ⅳ痔，双荷包缝合切除直肠黏膜宽度、黏膜环完整度、痔核回缩明显优于单荷包组（Plt;0.05），但术中出血、术中下腹部疼痛、术后肛门疼痛明显多于单荷包组，手术时间明显长于单荷包组（Plt;0.05）。结论 双荷包缝合与单荷包缝合各有利弊。对于Ⅲ度痔,取用单荷包缝合已达到治疗目的,但需掌握荷包缝合技巧。而对于Ⅳ度痔或合并直肠黏膜脱垂者,取用双荷包缝合更合适。 【关键词】 内痔;PPH;荷包缝合 [Abstract] Objective To investigate a more ideal technique of pursestring suture in procedure for prolapse and hemorrhoids (PPH). Methods A total of 183 cases of Ⅲ and Ⅳ degree prolapsed hemorrhoids were treated by PPH. Group A was with improved pursestring suture and group B with unimproved pursestring suture. Results For Ⅲdegree hemorrhoid, the indexes of width of excised rectum mucosal ring, the correction of prolaposed hemorrhoid in group A were significantly superior to that in group B, while the operation time, intraoperative abdominal pain, intraoperative bleeding, postoperative anal pain, postoperative anal bleeding and hospital stay showed no significant differences between two groups (Pgt;0.05). For Ⅳdegree hemorrhoid, compared with group B, the indexes of the width of excised mucosal ring and the correction of the prolapsed hemorrhoid rate were significantly superior in group A（Plt;0.05）, but more intraoperative bleeding, more incidence of lower abdominal pain and postoperative anal pain, longer operation time were found in group A （Plt;0.05）. Conclusion For Ⅲdegree hemorrhoid, single pursestring suture can reach the aim of treatment, but pursestring suture technique should be mastered. For Ⅳdegree hemorrhoid or prolapse of rectum mucosal, double pursestring suture are more suitable. [Key words] Internal hemorrhoid; Procedure for prolapse and hemorrhoids; Pursestring suture PPH(procedure for prolapse and hemorrhoids)是近年来治疗痔病的重要进展之一。PPH虽然有诸多优点,但也有较多不足之处，如术中吻合口出血、下腹部疼痛，术后出血、肛门不适、残留皮赘或痔核脱垂。其原因与黏膜下荷包缝合有关。我院20