pph手术荷包缝合技术的临床探讨

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1、PPH手术荷包缝合技术的临床探讨(附183例报告)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（P<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（P<0.05），但术中出血、术中下

2、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（P<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   Clinialinvestigationofthepursestringsuturetechniqueinprocedureforprolapseandhemorrhoids(reportof183cases)   LiaoJiannan,QiuLei,XiePeibiao,eta

3、l.DepartmentofColoproctology,FoshanSecondpeople'sHospital,Foshan528000,Guangdong,China   [Abstract] Objective Toinvestigateamoreidealtechniqueofpursestringsutureinprocedureforprolapseandhemorrhoids(PPH).MethodsAtotalof183casesofⅢandⅣdegreeprolapsedhemorrhoidsweretreatedbyPPH.Grou

4、pAwaswithimprovedpursestringsutureandgroupBwithunimprovedpursestringsuture.ResultsForⅢdegreehemorrhoid,theindexesofwidthofexcisedrectummucosalring,thecorrectionofprolaposedhemorrhoidingroupAweresignificantlysuperiortothatingroupB,whiletheoperationtime,intraoperativeabdominalpai

5、n,intraoperativebleeding,postoperativeanalpain,postoperativeanalbleedingandhospitalstayshowednosignificantdifferencesbetweentwogroups(P>0.05).ForⅣdegreehemorrhoid,comparedwithgroupB,theindexesofthewidthofexcisedmucosalringandthecorrectionoftheprolapsedhemorrhoidrateweresignifican

6、tlysuperioringroupA（P<0.05）,butmoreintraoperativebleeding,moreincidenceoflowerabdominalpainandpostoperativeanalpain,longeroperationtimewerefoundingroupA（P<0.05）.ConclusionForⅢdegreehemorrhoid,singlepursestringsuturecanreachtheaimoftreatment,butpursestringsuturetechniqueshouldbe

7、mastered.ForⅣdegreehemorrhoidorprolapseofrectummucosal,doublepursestringsuturearemoresuitable.   [Keywords] Internalhemorrhoid;Procedureforprolapseandhemorrhoids;Pursestringsuture   PPH(procedureforprolapseandhemorrhoids)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、

8、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