| 姑丽尼格尔·吾不力哈斯木,马木提江·阿巴拜克热.混合痔选择性痔上黏膜吻合术 278例荷包缝合高度与深度的选择[J].安徽医药,2020,24(3):463-467. |
| 混合痔选择性痔上黏膜吻合术 278例荷包缝合高度与深度的选择 |
| Selection of height and depth of TST for 278 patients with mixed hemorrhoids |
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| DOI：10.3969/j.issn.1009?6469.2020.03.011 |
| 中文关键词: 痔 结直肠外科手术 缝合技术 水肿 疼痛，手术后 治疗结果 选择性痔上黏膜吻合术 |
| 英文关键词: Hemorrhoids Colorectal surgery Suture techniques Edema Pain,postoperative Treatment outcome Se? lective superior hemorrhoidal mucosa resection and anastomosis |
| 基金项目:国家自然科学基金项目( 81460133) |
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| 中文摘要: |
| 目的探讨荷包缝合距齿状线高度的选择以及荷包缝合深度对选择性痔上黏膜吻合术( TST)治疗混合痔临床疗效的影响。方法回顾性分析 2016年 1月至 2018年 12月新疆医科大学第一附属医院用 TST术治疗的 278例混合痔病人的临床资料，按荷包缝合高度分为两组: A组病人的荷包缝合高度在齿状线上 1.5～2.5 cm，共 121例， B组病人在齿状线上 2.5～4.0 cm，共 157例。按术中切除标本的病理检查结果分为两组: α组病人病理结果中可见肌层，表明荷包缝合深度达直肠壁肌层，共 148例， β组病人病理结果未见肌层，表明荷包缝合只达黏膜下层，共 130例。分别从两种分组方法观察各组病人术中情况及术后并发症的发生。术后随访 1～5个月。结果 A组与 B组的治愈率(分别为 98.35%、96.82%)、手术时间、术中出血量、术中缝扎吻合口活动性出血例数、术后出血量比较，均差异无统计学意义(均 P＞0.05)。 A组病人术后疼痛评分高于 B组， A组病人术后肛缘水肿及肛门坠胀不适感发生率显著低于 B组(均 P＜0.05)。 α组与 β组的治愈率(分别为 97.97%、96.92%)、手术时间、术后疼痛评分比较，均差异无统计学意义(均 P＞0.05)。 α组病人术中出血量、术中缝扎吻合口活动性出血例数、术后出血量、术后肛缘水肿及肛门坠胀不适感发生率均低于 β组(均 P＜0.05)。结论 TST术中降低荷包高度为距齿状线上 1.5～2.5 cm可有效减少术后肛缘水肿及肛门坠胀不适感发生率，悬吊效果佳，但是病人术后疼痛明显。荷包缝合深度应至直肠黏膜下层，可减少出血及术后并发症。 |
| 英文摘要: |
| Objective To explore the effect of the choice of the dentate line of the purse?string suture height and the depth of thepurse?string suture on the clinical efficacy of the mixed hemorrhoids in TST.Methods The clinical data of 278 patients with mixedhemorrhoids treated with TST in the First Affiliated Hospital of Xinjiang Medical University from January 2016 to December 2018were retrospectively analyzed.They were divided into two groups according to the height of the purse stitching:The height of purse? string suture in group A was 1.5 cm to 2.5 cm on the dentate line，a total of 121 cases，and in group B patients were 2.5 cm to 4.0 cm on the dentate line，a total of 157 cases.The pathological examination results of the surgically removed specimens were divided into two groups:in α group，the muscle layer was seen，indicating that the purse?string suture depth reached the rectal wall muscle layer，a total of 148 cases.The pathological results of the β group showed no muscle layer，indicating that the purse?string suture only reached the submucosal layer，a total of 130 cases.The intraoperative conditions and postoperative complications of each group wereobserved.The patients were followed up for 1 to 5 months.Results There were no significant differences in the cure rate(98.35% and 96.82%，espectively)，operation time，intraoperative blood loss，intraoperative suture anastomotic active bleeding，and postopera? tive bleeding between group A and group B(both P＞0.05).The postoperative pain score of group A was higher than that of group B， and the difference was statistically significant(P＜0.05).The incidence of postoperative anal edema and anal bulge discomfort in group A was significantly lower than that in group B(P＜0.05).There were no significant differences in the cure rate(97.97% and 96.92%，respectively)，operation time and postoperative pain score between the α group and the β group(both P＞0.05).The intra? operative blood loss，the number of intraoperative sutures and anastomotic bleeding，and the postoperative blood loss were lower in the α group than those in the β group(P＜0.05).The incidence of postoperative anal edema and anal bulge discomfort in patients inthe α group was significantly lower than that in the β group，and the difference was statistically significant(P＜0.05).Conclusions In the TST，the height of the purse is reduced from 1.5 cm to 2.5 cm from the dentate line，which can effectively reduce the inci? dence of postoperative anal edema and anal bulge discomfort.The suspending effect is good，but the postoperative pain is obvious. The depth of the purse should be sutured to the lower rectal mucosa，which can reduce bleeding and postoperative complications. |
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