作者单位：620500 仁寿，四川省仁寿县人民医院普外二科

采用国产吻合器及分次双荷包缝合的痔上黏膜环切术治疗重度痔的疗效

向威苏波徐长青汪树利

【摘要】目的探讨采用国产吻合器及改良荷包缝合法(分次双荷包缝合)的改良痔上黏膜环切术( PPH)治疗Ⅲ～Ⅳ期重度痔的疗效。方法将120例Ⅲ～Ⅳ期重度痔患者随机分为分次双荷包缝合组、单荷包缝合组、1次性双荷包缝合组各40例，比较3组的手术时间、术中出血量、黏膜环切除宽度、黏膜环均匀程度、术后并发症等手术指标，并比较手术总体疗效。结果总体比较结果显示，3组的术中出血量(F=13.299, P<0.001)、黏膜环切除宽度(F=42.015, P<0.001)、黏膜环均匀程度(χ2=6.104, P=0.047)、总体疗效(χ2=7.222, P=0.027)比较差异均有统计学意义(P均<0.05)。两两比较结果显示，分次双荷包缝合组术中出血量、黏膜环宽度、黏膜环均匀程度、治愈率均优于另外2组(P均<0.017)。结论采用国产吻合器及分次双荷包缝合的PPH治疗Ⅲ～Ⅳ期重度痔疗效较好。

【关键词】痔上黏膜环切；国产吻合器；痔；临床效果

DOI:10.3969/g.issn.0253-9802.2015.07.009

Abstract【】ObjectiveTo investigate the clinical effect of a modified procedure for prolapse and hemorrhoids (PPH) using a domestic stapler and a two-step double purse-string suture (PSS) on the treatment of severe hemorrhoids (stage Ⅲ-Ⅳ). MethodsA total of 120 patients with stage Ⅲ-Ⅳ hemorrhoids were randomly and equally divided into three groups, including a two-step double PSS group, a single PSS group, and a one-step double PSS group (n=40 each). Surgical indices, including the operation time, intraoperative blood loss, width and uniformity of the excisional mucosal stoma ring, and postoperative complications, were compared between the three groups. The overall effect of the PPH procedure was evaluated by comparative analysis. ResultsA comparison between the three groups of patients showed statistically significant differences (P<0.05) in the intraoperative blood loss (F=13.299, P<0.001), width of the excisional mucosal stoma ring (F= 42.015,P<0.001), uniformity of the excisional mucosal stoma ring (χ2 = 6.104, P=0.047), and overall effect (χ2=7.222, P=0.027). Pairwise comparisons revealed that the two-step double PSS group achieved better outcomes than the other two groups in terms of the intraoperative blood loss, width and uniformity of the excisional mucosal stoma ring, and cure rate (P<0.017). ConclusionThe modified PPH procedure using a domestic stapler and a two-step double PPS is effective for the clinical treatment of stage Ⅲ-Ⅳ hemorrhoids.

收稿日期：(2015-02-03)

Clinical effect of a procedure for prolapse and hemorrhoids using a domestic stapler and a two-step double purse-string suture on the treatment of severe hemorrhoidsXiangWei,SuBo,XuChangqing,WangShuli.RenshouPeople’sHospital,Renshou620500,China

【Key words】Procedure for prolapse and hemorrhoids; Domestic stapler; Hemorrhoid; Clinical effect

痔是外科常见病，Ⅲ、Ⅳ期内痔或混合痔通常需要手术治疗。痔上黏膜环切术(PPH)相对于传统手术的优越性已毋庸置疑[1-2]。PPH能减轻术后疼痛，且手术时间短，患者术后恢复迅速，基本不存在复发[3-4]。但是进口1次性吻合器价格昂贵，不易推广普及，因此，笔者在对Ⅲ～Ⅳ期重度痔患者行PPH的操作过程中采用了国产吻合器及改良荷包缝合法(分次双荷包缝合)，取得了较好疗效，现将相关研究结果报告如下。

对象与方法

一、研究对象

选择2010年1月至2014年12月在我科接受治疗的Ⅲ～Ⅳ期重度痔患者120例为研究对象。其中男52例、女68例，年龄(44.5±10.8)岁，病程(11.2±4.4)年；Ⅲ期内痔37例，Ⅳ期内痔49例，混合痔(以内痔为主)34例。120例的主要症状包括出血、脱垂、肛周污便伴湿疹瘙痒，其中11例伴痔核嵌顿，所有患者内痔均呈环形脱出。全部患者均拟行PPH，采用随机数字表法，按照患者住院号将其随机分为分次双荷包缝合组、1次性双荷包缝合组、单荷包缝合组各40例，3组患者在性别、年龄、病程之间比较差异均无统计学意义(P均>0.05)，具可比性，见表1。所……