手术治疗Ⅲ\Ⅳ度痔患者的术式比较(1)
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[摘要] 目的 比较开环式微创痔吻合术(TST)及吻合器痔上黏膜环切术(PPH)治疗Ⅲ、Ⅳ度痔的疗效。方法 100例Ⅲ、Ⅳ度痔患者分成观察组和对照组，对照组采用PPH术，观察组采用TST术。结果 观察组脱垂率、出血消失率、直肠静息压及肛管静息压与对照组相比，差异无统计学意义(P>0.05)；观察组手术时间、住院时间、出血量均少于对照组，差异有统计学意义(P<0.05)。结论 TST治疗Ⅲ、Ⅳ度痔病是一种比较可靠的治疗方法，而且副作用较小。
[关键词] 开环式微创痔吻合术；吻合器痔上黏膜环切术；痔；直肠静息压；肛管静息压
[中图分类号] R657.1+8[文献标识码] B[文章编号] 1673-9701(2011)25-59-02
Comparison of Surgical Procedures in Treatment of Ⅲ, Ⅳ Degrees Hemorrhoids
HUANG Fengping
Department of Surgery, Fuyuan Hospital in Yiwu, Yiwu 322000, China
[Abstract] Objective To compare the surgical procedures of tissue-selecting therapy stapler (TST) and procedure for prolapse and hemorrhoids (PPH) in treatment of Ⅲ, Ⅳ degrees hemorrhoids. Methods One hundred patients with Ⅲ, Ⅳ degrees hemorrhoids were divided into observation group and control group. Control group received PPH and observation group received TST. Results Prolapse, bleeding disappearance rate, rectum resting pressure and anal canal resting pressure of the observation group compared with control group, the difference was not significant (P>0.05). The operation time, time of hospitalization and blood loss of observation group were less than those of control group, and there were significant differences (P<0.05). Conclusion TST in treatment of Ⅲ, Ⅳ degrees hemorrhoids has good efficacy.
[Key words] Tissue-selecting therapy stapler; Procedure for prolapse and hemorrhoids; Hemorrhoid; Rectum resting pressure; Anal canal resting pressure
开环式微创痔吻合术(tissue-selecting therapy stapler，TST)也称选择性吻合器痔切闭术，是在吻合器痔上黏膜环切术(procedure for prolapse and hemorrhoids，PPH)的基础上进行改良的新技术。本文中，笔者分别采用TST及PPH治疗Ⅲ、Ⅳ度痔患者，并做其疗效比较，现报道如下。
1资料与方法
1.1一般资料
选择2010年4月～2011年4月在本院就诊的Ⅲ、Ⅳ度痔[1]患者100例，男46例，女54例，年龄24～62岁；按就诊顺序随机分为观察组和对照组两组。纳入标准：Ⅲ、Ⅳ度痔患者；对研究人员有良好的依从性；签订知情同意书。排除标准：排除特异性感染及嵌顿型混合痔者；排除心肺肝肾功能严重不全者；排除瘢痕体质、过敏体质者；排除在外院做过痔手术未愈合者。观察组50例，男22例，女28例，平均年龄(40.6±15.6)岁；对照组50例，男24例，女26例，平均年龄(41.3±13.7)岁。两组Ⅲ、Ⅳ度痔患者病例数、年龄等一般资料差异无统计学意义(P>0.05)，具有可比性。
1.2治疗方法
①对照组：采用PPH术[2]治疗。②观察组：采用TST手术。根据患者具体病情，选择合适肛门镜；扩肛，插入肛门镜，充分显露痔上黏膜。肛门镜旋转，使痔上黏膜位于开环式的窗口内。两个痔核可进行两点黏膜下缝合引线牵引。三个以上痔核可分段性荷包缝合。一次性痔吻合器头部插入直肠内，旋紧痔环形吻合器的尾翼，击发，完成切割和吻合。固定一次性痔吻合器等待20s后，拔出。若患者的两个吻合口间有搭桥，可直接剪断 ......
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