吻合器痔上粘膜环切术与传统外剥内扎术的临床对比研究
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摘要
目的 探讨吻合器痔上粘膜环切术(procedure for prolapse and hemorrhoids，PPH)的适应证、方法、临床应用价值及与传统Milligan-Morgan(外剥内扎)术比较有何种优点。
方法 总结30例PPH手术(Ⅰ组)和30例Milligan-Morgan手术(Ⅱ组)，分别对其手术时间、术后疼痛指数、住院时间、并发症及住院费用等进行对比研究。
结果 Ⅰ组手术时间、术后疼痛指数、住院时间明显少于Ⅱ组，Ⅰ组住院费用高于Ⅱ组，早期轻度大便失禁等的并发症发生率Ⅰ组明显少于Ⅱ组。
结论 PPH治疗Ⅲ°—Ⅳ°痔的近期疗效优于Milligan-Morgan手术，且具有安全、有效、手术时间短、住院时间少、恢复快等优点。
Objective: To evaluate the efficacy of the procedure for prolapse and hemorrhoid (PPH) in the treatment of patients with severe hemorrhoids (grade III IV), whether to take advantage of Milligan-Morgan operation.
Methods: 30 cases(group I) of hemorrhoids at the third or fourth degree were operated by PPH and other 30 cases(group II) by Milligan-Morgan. Compare the operating time, hospitalization time, complications and the cost of these two groups.
Results: Except for the cost , the group PPH is much better than the Milligan -Morgan group in terms of operating time, pain index, length of hospital stay. For complications, the incidence of occurrence of anal discharge in group I is much lower than that of group II.
Conclusion: PPH is a safe and effective procedure for III, IV hemorrhoids and its shorter term outcome is better than Milligan- Morgan procedure.
方法 总结30例PPH手术(Ⅰ组)和30例Milligan-Morgan手术(Ⅱ组)，分别对其手术时间、术后疼痛指数、住院时间、并发症及住院费用等进行对比研究。
结果 Ⅰ组手术时间、术后疼痛指数、住院时间明显少于Ⅱ组，Ⅰ组住院费用高于Ⅱ组，早期轻度大便失禁等的并发症发生率Ⅰ组明显少于Ⅱ组。
结论 PPH治疗Ⅲ°—Ⅳ°痔的近期疗效优于Milligan-Morgan手术，且具有安全、有效、手术时间短、住院时间少、恢复快等优点。
Objective: To evaluate the efficacy of the procedure for prolapse and hemorrhoid (PPH) in the treatment of patients with severe hemorrhoids (grade III IV), whether to take advantage of Milligan-Morgan operation.
Methods: 30 cases(group I) of hemorrhoids at the third or fourth degree were operated by PPH and other 30 cases(group II) by Milligan-Morgan. Compare the operating time, hospitalization time, complications and the cost of these two groups.
Results: Except for the cost , the group PPH is much better than the Milligan -Morgan group in terms of operating time, pain index, length of hospital stay. For complications, the incidence of occurrence of anal discharge in group I is much lower than that of group II.
Conclusion: PPH is a safe and effective procedure for III, IV hemorrhoids and its shorter term outcome is better than Milligan- Morgan procedure.
引文
1. Milligan ETC, Morgan CN. Surgical anatomy of the anal canal and operative treatment of haemorrhoids. Lancet 1937; 2:1119-24.
2. Marino AW Jr. Anorectal surgery hemorrhoids. Dis Colon Rectum, 1980, 23:211—222.
3．姚礼庆，唐竞，徐美东，等吻合器粘膜环切术治疗重度痔的临床价值[J]中国肛肠病杂志，2002，22(3)：24．
4. Brian JM,John RTM, John EH. Stapling procedure for haemorrhoids versus Milligair Morgan haernorrhoidectomy:randomised controlled trial Lancet, 2000,355:782-785.
5. Beattie GC, Lam JPH, Loudon MA. A prospective evaluation of the intro duction of circumferential stapled anoplasty in the management of haemorrhoids and mucosal prolapse. Colorectal Disease, 2000, 2:1—6.
6. MC.Marti. Surgical Management of Anorectal and colonic diseases. 2th ed. Berlin: Springer. 1998,123
7. GunnarA,Hans K, StaffanH. Closed vs.open hemorrhoidectomy is there any difference. Dis Colon Rectum, 2000,43:31—34.
8．张东铭痔的现代概念及其解剖生理学基础[J]，中国肛肠病杂志，2001，3(1)：26-29．
9. Thomson WHF. The nature of hemorrhoids[J] Br J Surg, 1975, 62 (5):542-52.
10. Haas PA, Fox TA, Haas GP. The pathogenesis of hemorrhoids [J] Dis Colon Rectum, 1984, 27: 442-50.
11. Fazio VW. Early promise of stapling technique for haemorrhoidectomy[J]. Lancet,2000,355(9206):768-769.
12. Sun WM, Read NW, Sharthouse AJ.Hypertensive anal cushions as a cause
of the high anal canal pressures in patients with haemorrhoids. Br J Surg, 1990, 77:458-461.
13. Kolbert GW, Raulf F. Evaluation der ergebnisse der geschlossenen staplerhamorrhoidektomie nach longo durch dopplersonografischa untersuchung der arteria rectalis superior. Zentralbl Chir, 2002,127:19-21.
14. Fenger. The anal transitional zone[ C].Acta Path M icrobiol Scand Sect, 1979, A87: 379.
15. Havrylenko SP. Results of the surgical treatment of acute hemorrhoidal thrombosis. Klin Khir, 1998, (4) :28—29.
16．杨新庆，吻合器痔上粘膜钉合术学术研讨会纪要[J]中华外科杂志， 2002，40(10)：795．
17. Vexmeulen FD, Nvatvongs S, Fang DT, et al. A technique for perineal rectosigmoidectomy using autosuture devices. Surg Gyn Obster, 1983, 156:84.
2. Marino AW Jr. Anorectal surgery hemorrhoids. Dis Colon Rectum, 1980, 23:211—222.
3．姚礼庆，唐竞，徐美东，等吻合器粘膜环切术治疗重度痔的临床价值[J]中国肛肠病杂志，2002，22(3)：24．
4. Brian JM,John RTM, John EH. Stapling procedure for haemorrhoids versus Milligair Morgan haernorrhoidectomy:randomised controlled trial Lancet, 2000,355:782-785.
5. Beattie GC, Lam JPH, Loudon MA. A prospective evaluation of the intro duction of circumferential stapled anoplasty in the management of haemorrhoids and mucosal prolapse. Colorectal Disease, 2000, 2:1—6.
6. MC.Marti. Surgical Management of Anorectal and colonic diseases. 2th ed. Berlin: Springer. 1998,123
7. GunnarA,Hans K, StaffanH. Closed vs.open hemorrhoidectomy is there any difference. Dis Colon Rectum, 2000,43:31—34.
8．张东铭痔的现代概念及其解剖生理学基础[J]，中国肛肠病杂志，2001，3(1)：26-29．
9. Thomson WHF. The nature of hemorrhoids[J] Br J Surg, 1975, 62 (5):542-52.
10. Haas PA, Fox TA, Haas GP. The pathogenesis of hemorrhoids [J] Dis Colon Rectum, 1984, 27: 442-50.
11. Fazio VW. Early promise of stapling technique for haemorrhoidectomy[J]. Lancet,2000,355(9206):768-769.
12. Sun WM, Read NW, Sharthouse AJ.Hypertensive anal cushions as a cause
of the high anal canal pressures in patients with haemorrhoids. Br J Surg, 1990, 77:458-461.
13. Kolbert GW, Raulf F. Evaluation der ergebnisse der geschlossenen staplerhamorrhoidektomie nach longo durch dopplersonografischa untersuchung der arteria rectalis superior. Zentralbl Chir, 2002,127:19-21.
14. Fenger. The anal transitional zone[ C].Acta Path M icrobiol Scand Sect, 1979, A87: 379.
15. Havrylenko SP. Results of the surgical treatment of acute hemorrhoidal thrombosis. Klin Khir, 1998, (4) :28—29.
16．杨新庆，吻合器痔上粘膜钉合术学术研讨会纪要[J]中华外科杂志， 2002，40(10)：795．
17. Vexmeulen FD, Nvatvongs S, Fang DT, et al. A technique for perineal rectosigmoidectomy using autosuture devices. Surg Gyn Obster, 1983, 156:84.