目的:总结吻合器痔上黏膜环切术(PPH)治疗痔病的经验。探讨该术式的有关问题,以便提高疗效。方法:回顾性分析了2001~2006年8月收治痔病541例,其中PPH术42例的临床资料。本组均为Ⅲ度或Ⅳ度痔。局部合并症共22例次:血栓外痔愈合后遗留皮赘14例,肛裂2例。有关全身合并症:前列腺增生7例,慢性泌尿系统感染1例。结果:42例中,35例术后2~5天出院,6例自愿留院到7天,1例慢性尿路感染者术后2~7天多次便血,再次手术后28日痊愈出院。随访13~24个月:32例恢复满意,10例有肛门包块感及包块排粪时轻度脱出,其中3例经进一步处理缓解,另7例观察治疗。结论:(1)PPH手术简单易行,疼痛轻,住院时间短,效果好。(2)为了提高效果术中应注意:①禁忌症为单个痔块脱出和肛管皮肤不平滑并纤维化的Ⅳ度病变者外。我们还发现慢性泌尿系统感染未彻底治愈者也应视为相对禁忌。明显前列腺增生者也应慎重。②术中按经典PPH手术的要求进行操作,扩肛器插入前后,不宜扩肛和下牵痔块。③个别巨大痔块及皮赘性痔块(tag)宜先行切除,再行本术。④重度脱出者,黏膜切除应宽大,必要时切除部分肛垫。
目的观察吻合器痔上黏膜环形切除钉合术(procedure for prolapse and hemorrhoids,PPH)治疗老年女性患者直肠前突的临床疗效。方法回顾性分析我科2004年10月至2010年8月期间经PPH治疗的63例老年女性直肠前突患者的手术经过及术后疗效。结果本组63例患者手术均顺利,手术时间13~35 min (平均21 min),住院时间3~7 d (平均5 d),无直肠阴道瘘、肛周脓肿等并发症发生。术后2周均行肛门指诊,2例有轻度炎症,给予对症治疗1周后炎症消失。3例吻合钉未完全脱净,少量残留,给予取出残钉后不适症状消失。术后随访0.5~5年(平均3年),随访率为95.24%(60/63),临床症状完全消失61例,治愈率为96.83%; 症状好转2例,对好转的2例行排粪造影检查,前突均明显减轻,且便秘症状较前有所缓解。结论PPH治疗老年女性直肠前突安全、有效,便秘症状缓解明显,是一种适合临床应用的手术方式。
目的 评估多普勒超声引导的痔上动脉结扎治疗Ⅱ、Ⅲ度内痔的临床应用价值。方法 对2009 年4~9月期间在我科行多普勒超声引导的痔上动脉结扎的49 例Ⅱ、Ⅲ度内痔患者从术后肛门括约肌功能、症状有效改善情况、疼痛程度及完全恢复正常生活所需时间方面进行评价。结果 术后无患者出现肛门括约肌功能失调;术后1 周、1 个月及3 个月Ⅱ、Ⅲ度内痔分别有77.8%(42/54)、87.0%(47/54)、92.6%(50/54)和59.4%(19/32)、71.9%(23/32)、78.1%(25/32)的患者单项症状得到有效改善; 术后6 h及24 h VAS 法疼痛程度评分平均分分别为1.95分和1.63分; 患者完全恢复正常生活所需时间平均为术后2.98 d。结论 多普勒超声引导的痔上动脉结扎治疗Ⅱ、Ⅲ度内痔安全有效,术后疼痛较轻且可以较快地完全恢复正常生活。
Objective To investigate the clinical curative effect of divided excision and plastic combined with procedure for prolapse and hemorrhoids (PPH) in treatment for circular mixed hemorrhoids. Methods Clinical observation on 120 patients with circular mixed hemorrhoids between May 2007 and May 2008 treated by divided excision and plastic combined with PPH was carried out. Results The mean hospital stay after operation was 7.6 d. The wound healing average time was 11.9 d. The incidence rate of postoperative urinary retention was 5.8% (7/120). Average scores of pain in 3 d after operation: 5.3 points (1-8 points) on day 1, 3.6 points (2-9 points) on day 2, 2.2 points (1-8 points) on day 3. All patients were followed up for 12 months, there were 3 cases of hematochezia, 1 case of prolapse, and 1 case of remained abnormal outgrowth skin; the anus function was normal in all cases without anal stricture or tightening feeling. Conclusions Divided excision and plastic combined with PPH can better treat circular mixed hemorrhoids. This operation can not only completely clear the lesions, but also repair and reconstruct the anus and anal canal, protect its size and function. It is an ideal operation for treatment for circular mixed hemorrhoids.
目的 对痔切除吻合器痔上黏膜环切术(PPH)与传统手术在治疗混合痔环状脱垂或内痔环状脱垂的疗效进行比较。方法 回顾性分析2002年1月至2004年9月西苑医院收治的832例经内镜确诊为内痔及混合痔患者的临床资料。结果 PPH组: 混合痔247例,治愈228例(92.3%),显效19例(7.7%); 内痔168例均治愈(100%); 术后发生大出血2例(0.5%),住院时间3.1~6.3 d,无一例创面感染。传统手术组: 混合痔229例中治愈215例(93.9%),显效14例(6.1%); 内痔188例中治愈175例(93.1%),显效13例(6.9%); 术后发生出血3例,肛管狭窄12例,并发症发生率为3.6%,住院时间26.2~27.1 d。结论 对痔的环形脱垂,采用PPH手术并与外痔切除或外剥内扎方法相结合,具有手术操作简单、安全、术后疼痛轻、恢复快等特点,优于传统的外剥内扎手术。
目的 探讨嵌顿环状混合痔的手术治疗方法。 方法 回顾性总结我院1998年1月至2002年1月采用小切口外剥内扎硬注术治疗嵌顿环状混合痔30例临床经验。 结果 30例患者手术过程顺利,手术时间平均50 min,平均住院时间10 d,术后并发肛门Ⅰ度水肿4例,术后当天排尿困难1例,经对症治疗后痊愈出院。本组病例术后随访1年均无复发。 结论 该术式能迅速减轻患者痛苦,且疗效满意。
目的 探讨吻合器痔上黏膜环切术(PPH)对巨大型Ⅲ、Ⅳ度环状痔的临床应用价值。方法 采用美国强生公司生产的痔疮吻合器对38例巨大型Ⅲ、Ⅳ度环状痔患者进行手术,并分析其临床资料。结果 患者平均手术时间19 min,术后平均住院2.8 d,术后10例肛门疼痛较剧者使用了镇痛剂(其中6例加切了外痔),13例有轻度疼痛,15例无疼痛。术后9例1~6 d有便血,其中1例为大出血,出血量约1 000 ml,均经保守治疗后好转。随访1~19个月,患者无大便失禁、肛周感染、脓肿及肛门狭窄发生。结论 PPH治疗巨大型Ⅲ、Ⅳ度环状痔具有手术时间短、住院时间少、痛苦小、恢复快、疗效显著、并发症少的优势。
Objective To evaluate treatment of the bleeding and prolapse of hemorrhoids by copper ion electrochemistry.Methods All patients suffered from the bleeding and prolapse of internal hemorrhoids or mixed hemorrhoids were included in this study. There were 202 patients in trial group (79 patients with internal hemorrhoids,123 patients with mixed hemorrhoids). Control group contained 171 cases (64 patients with internal hemorrhoids,107 patients with mixed hemorrhoids). There were 56 patients with prolapse of inner hemorrhoids or mixed hemorrhoids. Copper ion electrochemistry was performed in trial group. Suppository was used in control group. After the rectum was sterilized, the copper needle was inserted into the hemorrhoid with the depth about 8-15 mm. Then we continued the therapy for 4 minutes and 40 seconds. Other hemorrhoids were treated in the same way. Results The cure rate in trial group with hemorrhoidal bleeding was 98.0%,special virtual rate was 1.50%,virtual rate was 0.5%, inefficiency rate was 0 (U=44.6,Plt;0.001). The cure rate in control group was 11.1%,special virtual rate was 24.6%,virtual rate was 28.1%,inefficiency rate was 36.3%. The cure rate of prolapse group was 48.2%,special virtual rate was 33.9%,virtual rate was 17.9%. The patients didn’t feel uncomfortable and recovered 4 hours later after operation. Conclusion This therapy was safe, effective and simple.
目的 探讨混合痔切除外剥内扎术术式的改进方法。方法 应用该改进术式共治疗混合痔1126例,切除混合痔2489个,其中一次切除痔在3个以上乃至近环行切除仅留1 cm皮桥者450例,混合痔1461个。结果 术后创面渗血、疼痛及愈合时间均明显优于传统混合痔外剥内扎术; 术后排便通畅,随访6个月,无一例出现肛门狭窄; 创面愈合后疤痕较轻,外形美观,能最大程度恢复原肛门解剖结构和生理功能。结论 该术式方法简单、实用,克服了传统手术的不足。