开环式微创痔吻合术治疗脱垂性痔病术后肛管直肠口径变化的临床研究
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摘要
目的通过测量开环式微创痔吻合术、外切内扎术术前术后患者肛管直肠口径,观察术前术后患者肛管直肠口径的变化和肛门功能的观察评分,比较开环式微创痔吻合术和外切内扎术术后该肛管直肠口径的变化,及其变化对术后排便通畅程度的影响。
方法选择40例病人,在签署知情同意书的前提下,按照随机原则分为治疗组和对照组。治疗组采用开环式微创痔吻合术(TST)治疗,对照组采用外切内扎术治疗,对两组病人的手术时间、术中出血量、术后肛管直肠口径的变化、排便通畅程度、急便感、肛门坠胀、术后脱出情况、术后出血情况、术后肛门功能、术后肛门疼痛情况、住院时间等方面进行比较。
结果开环式微创痔吻合术(TST)的术后出血、脱出、排便通畅程度、急便感、肛门功能、手术时间、术中出血量、住院时间方面与外切内扎术相比均无统计学意义(P>0.05)；开环式微创痔吻合术(TST)在术后肛管直肠口径的变化、术后肛门疼痛、术后肛门坠胀方面与外切内扎术相比均有统计学意义(P<0.05)。
结论开环式微创痔吻合术(TST术)在治疗脱垂性痔病术后脱垂、出血、排便通畅程度、急便感、肛门自制功能、手术时间、术中出血量、住院时间方面与对照组相似,在减小术后肛管直肠口径的变化、术后肛门疼痛方面开环式微创痔吻合术(TST术)较外切内扎术具有明显的优势,在术后肛门坠胀方面外切内扎术相对于开环式微创痔吻合术(TST术)具有明显的优势。
Objective:By measuring the Tissue-Selecting Therapy stapler with Milligan-Morgan of preoperative and postoperative patients with anal canal diameter measurement, observation of preoperative and postoperative patients with anal canal diameter change and anal function observed score proved TST can effectively maintain the anal pad and the anal mucosa integrity, and its changes on postoperative bowel patency degree of influence.
Methods:Select40patients with Ⅲ-Ⅳ degree prolapsed hemorrhoids, according to randomly assigned into treatment group (Tissue-Selecting Therapy stapler TST group) and control group (Milligan-Morgan M-Mgroup) to observed the two groups of patients after treatment, the duration of operation, intraoperative blood loss, postoperative anal canal diameter changes,defecate unobstructed degree, urgent sense, anus pendent bulge, postoperative prolapse cases, postoperative bleeding, postoperative anal function, postoperative anal pain, hospitalization time and other aspects comparison.
Results:No difference in the postoperative bleeding, prolapse, defecate unobstructed degree, urgent sense, anal homemade function, operation time, intraoperative blood loss, length of stay (P>0.05); while TST in postoperative anal canal diameter changes, postoperative anal pain, postoperative anal bulge with M-M are statistically significant (P<0.05).
Conclusion:The two operation styles for treatment of postoperative prolapse, bleeding, bowel patency, urgent, anal homemade function, operation time, intraoperative blood loss, length of stay in terms of similar efficacy,while in reducing postoperative anal canal diameter changes, postoperative anal pain TST than M-M has obvious advantages, in the postoperative anus pendent bulge with respect to the outer M-M relative to TST have a distinct advantage。
方法选择40例病人,在签署知情同意书的前提下,按照随机原则分为治疗组和对照组。治疗组采用开环式微创痔吻合术(TST)治疗,对照组采用外切内扎术治疗,对两组病人的手术时间、术中出血量、术后肛管直肠口径的变化、排便通畅程度、急便感、肛门坠胀、术后脱出情况、术后出血情况、术后肛门功能、术后肛门疼痛情况、住院时间等方面进行比较。
结果开环式微创痔吻合术(TST)的术后出血、脱出、排便通畅程度、急便感、肛门功能、手术时间、术中出血量、住院时间方面与外切内扎术相比均无统计学意义(P>0.05)；开环式微创痔吻合术(TST)在术后肛管直肠口径的变化、术后肛门疼痛、术后肛门坠胀方面与外切内扎术相比均有统计学意义(P<0.05)。
结论开环式微创痔吻合术(TST术)在治疗脱垂性痔病术后脱垂、出血、排便通畅程度、急便感、肛门自制功能、手术时间、术中出血量、住院时间方面与对照组相似,在减小术后肛管直肠口径的变化、术后肛门疼痛方面开环式微创痔吻合术(TST术)较外切内扎术具有明显的优势,在术后肛门坠胀方面外切内扎术相对于开环式微创痔吻合术(TST术)具有明显的优势。
Objective:By measuring the Tissue-Selecting Therapy stapler with Milligan-Morgan of preoperative and postoperative patients with anal canal diameter measurement, observation of preoperative and postoperative patients with anal canal diameter change and anal function observed score proved TST can effectively maintain the anal pad and the anal mucosa integrity, and its changes on postoperative bowel patency degree of influence.
Methods:Select40patients with Ⅲ-Ⅳ degree prolapsed hemorrhoids, according to randomly assigned into treatment group (Tissue-Selecting Therapy stapler TST group) and control group (Milligan-Morgan M-Mgroup) to observed the two groups of patients after treatment, the duration of operation, intraoperative blood loss, postoperative anal canal diameter changes,defecate unobstructed degree, urgent sense, anus pendent bulge, postoperative prolapse cases, postoperative bleeding, postoperative anal function, postoperative anal pain, hospitalization time and other aspects comparison.
Results:No difference in the postoperative bleeding, prolapse, defecate unobstructed degree, urgent sense, anal homemade function, operation time, intraoperative blood loss, length of stay (P>0.05); while TST in postoperative anal canal diameter changes, postoperative anal pain, postoperative anal bulge with M-M are statistically significant (P<0.05).
Conclusion:The two operation styles for treatment of postoperative prolapse, bleeding, bowel patency, urgent, anal homemade function, operation time, intraoperative blood loss, length of stay in terms of similar efficacy,while in reducing postoperative anal canal diameter changes, postoperative anal pain TST than M-M has obvious advantages, in the postoperative anus pendent bulge with respect to the outer M-M relative to TST have a distinct advantage。
引文
[1]张东铭.痔病(第1版)[M].北京：人民卫生出版社,2004：77.
[2]喻德洪,杨新庆,黄廷庭.重新认识提高痔的诊治水平[J].中华外科杂志,2000,38：890.
[3]Thomson WHF. The nature of hemorrhoids.Br JSurg,1975,62:542-552.
[4]刁飞宇.痔的现代概念及其诊治的现状和展望[J].广州医药,2007,38(1)：14-16.
[5]Longo A.Treatment of hemorrhoidal diease by reduction of mucosa and hemorrhoidal prolapse with a cir-Cular suturing device[M].a new procedure,Rome,Italy:Proceeding of the 6th Word Congress of Endosocopic Surgery,1998;3.
[6]Ravo. A.Amato,V. Bianco,et al.Complication afterstapler hemorrhoidectomy:can they be prevented[J]. Tech Coloproctol,2002,6:83-88.
[7]Molloy RG Kingsmore D. Life threatening pelvic sepsis after stapled haemorrhoidectomy[J]. Lancet, 2000,355(9206):810.
[8]Bayless TM. Current therapy in gastroenterology and liver disease[M].London:Mosby co,1984:316.
[9]黄帝内经素问[M].人民卫生出版社,1963：20.
[10]翟敏.中医肛肠病病因病机的古文探析[J].浙江中医药大学学报,2009,33(1)：21-22.
[11]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,2001,21(3)：27-30.
[12]Treitz F. Uber einen neuen Musket am Duodenum des Menschen,ubor elastische sehnen,und einige andere anatomische verhaltnisse[J]. Viertel Jahrschrift Prag Heilkunder(prager),1853,Ⅰ:113-114.
[13]Hass PA. The pathogenesis of hemorrhoids[J]. Dis Colon Rectum,1984,27(7):442.
[14]Lurz KH.Goltner E.Hamorrhoiden in Schwanger-schaftund Wochenbet[J]t.Munch Med Wochenschr 1977;119;1551.
[15]Goenka M,Kochhar R,Nagi B,et al.Rectosigmoid varices and other mucosal changes in patients with portal hypertension[J].Am J Gastroenterol 1991;86:1185
[16]李省吾.肛肠病诊治[M].上海：上海医科大学出版社,2000：45.
[17]黄乃健.中国肛肠病学[M].第一版.山东：山东科学技术出版社,1996：626-628.
[18]Jaeob DM.et al.The relationship of hemor-rhoidsros to portal hypertension[J].Dis Colonn Rectum,1980,23:563.
[19]中华医学会外科学分会结直肠肛门外科学组,痔临床诊治指南(2006版)[S],中华胃肠外科杂志：2006(5)：461-463.
[20]痔临床诊治指南(草案)[J]；中华胃肠外科杂志,2006,9(5)：461-463.
[21]唐云龙.中药内服外洗治疗内痔374例[J]；陕西中医1994年第15卷第4期.
[22]王艳梅,王宏波,李雪松.普济痔疮治疗内痔及混合制的临床观察[J].中国老年保健医学.2009,7(2)：113.
[23]Barwell J, Eatkins RM,Lloyd Davies E,et al. Life- threatening retroperitoneal sepsis after hemorrhoid injection sclerotherapy:report of a case[J]. Dis Colon Rectum,1999; 42(3):421-423.
[24]刘清德,赵杰芬.内痔注射外痔环切治疗环形混合痔[J].辽宁中医学院学报,2002,4(3)：212.
[25]荣文舟.中华肛肠病学图谱[M]；北京：科学技术文献出版社；1993：113.
[26]Murphy KJ.Tetanus after rubber band ligation of haemorrhoids[J]. Br Med J,1978; 1(6127):1590-1591.
[27]Wrobleski DE,Corman ML,Veidenheimer MC,et al.Longterm evaluation of rubber ring ligation in hermorrhoidal diseas[J]e.Dis Colon Rectum 1980;23;478.
[28]Lewis MI.Cryosurgical hemorrhoidectomy:a follow-up repor[J]t.Dis Colon Rectum 1972; 15;128.
[29]Neiger A. Hermorrhoids in everyday practice[J].Proctology 1979;2:22.
[30]Hosch SB, Knoefel WT, Pichlmeier U, et al. Surgical treatment of piles:Prospective, randomized study of Parks vs Milligan-Morgan hemorrhoidectomy[J]. Dis Colon Rectum,1998; 41:159-164.
[31]李春雨.实用肛门手术学[M].辽宁科学技术出版社,2005：112.
[32]Parks AG.Surgical treatment of haemorrhoids[J].Br J Surg 1956;43;337.
[33]Selvaggi F.Scotto di Carlo E,Silvestri A,et al.Surgical treatment of circumferential hemmorhoids[J].Dis Colon Rectum 1990;33;903.
[34]Arbman G, Krook H, Haapaniemis. Closed vs open hemorrhoidectomy—is there any diference? [J]. Dis Colon Rectum 2000; 43:61-34.
[35]Morinaga K,Hasuda K,Ikeda T.A novel therapy for internal hemorrhoids:ligation of the hemorrhoidal artery with a newly devised instrument(Moricom) in conjunction with a Doppler flow mete[J]r.Am J Gastroenterol 1995;90:610-613.
[36]Sohn N,Aronoff JS,Cohen FS,et al.Transanal hemorrhoidal dearterialization is an alternative to opreative hemorrhoidectomy[J].Am J Surg 2001;182:515-519.
[37]翁立平,季利江.超声多普勒引导下痔动脉结扎术治疗内痔的临床观察[J].结直肠肛门外科,2009；15(5)：300-303.
[38]Murphy KJ.Tetanus after rubber-band ligation[J].Br Med J,1978;(1):1590.
[39]傅传刚,张卫,王汉涛,等.吻合器环形痔切除术[J].中国实用外科杂志,2001,21(11)：653.
[40]罗湛滨,张思奋,任东林等.PPH治疗痔病的临床价值[J].大肠肛门病外科,2003,9(增刊)：4-5.
[41]姚礼庆,唐竞,孙益红,等.经吻合器治疗重度痔的临床应用价值：附36例报告[J].中国实用外科杂志,2001,21(5)：288-289.
[42]关瑞剑,赵江宁,罗湛滨,等.混合痔PPH术后5年随访分析[J].结直肠肛门外科,2009,15(4)：268.
[43]Pescatori M, Aigner F. Stapled transanal rectal mucosectomy ten years afte[J].Tech Coloproctol, 2007,16(11):1-6.
[44]成川江,王启.TST手术治疗痔病的临床观察[J].结直肠外科,2010,16(4)：240-243.
[45]林宏城,任东林,等.选择性痔上粘膜切除钉合术与痔上粘膜环切吻合术的对比研究[J].广东医学2011,32(11)：1457-1460.
[46]王业皇,章阳.开环式微创吻合器治疗呢痔病的临床效果[J].江苏医药,2010,36(11)：1249-1251.
[47]陈艳妮,江滨.PPH术后并发症的研究进展[J].结直肠肛门外科,2009,15(2)：136-138.
[48]Nobles VP.The development of the human anal canal[J].Janal 1984;138:575.
[49]张东铭,盆底与肛门病学[M].贵阳：贵州科技出版社,2000,1,17,18,25,76,144.
[50]张君曼.改良肛管扩张术治疗肛管狭窄运用探讨[J].新医学,2008,5,39,5：291-292.
[2]喻德洪,杨新庆,黄廷庭.重新认识提高痔的诊治水平[J].中华外科杂志,2000,38：890.
[3]Thomson WHF. The nature of hemorrhoids.Br JSurg,1975,62:542-552.
[4]刁飞宇.痔的现代概念及其诊治的现状和展望[J].广州医药,2007,38(1)：14-16.
[5]Longo A.Treatment of hemorrhoidal diease by reduction of mucosa and hemorrhoidal prolapse with a cir-Cular suturing device[M].a new procedure,Rome,Italy:Proceeding of the 6th Word Congress of Endosocopic Surgery,1998;3.
[6]Ravo. A.Amato,V. Bianco,et al.Complication afterstapler hemorrhoidectomy:can they be prevented[J]. Tech Coloproctol,2002,6:83-88.
[7]Molloy RG Kingsmore D. Life threatening pelvic sepsis after stapled haemorrhoidectomy[J]. Lancet, 2000,355(9206):810.
[8]Bayless TM. Current therapy in gastroenterology and liver disease[M].London:Mosby co,1984:316.
[9]黄帝内经素问[M].人民卫生出版社,1963：20.
[10]翟敏.中医肛肠病病因病机的古文探析[J].浙江中医药大学学报,2009,33(1)：21-22.
[11]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,2001,21(3)：27-30.
[12]Treitz F. Uber einen neuen Musket am Duodenum des Menschen,ubor elastische sehnen,und einige andere anatomische verhaltnisse[J]. Viertel Jahrschrift Prag Heilkunder(prager),1853,Ⅰ:113-114.
[13]Hass PA. The pathogenesis of hemorrhoids[J]. Dis Colon Rectum,1984,27(7):442.
[14]Lurz KH.Goltner E.Hamorrhoiden in Schwanger-schaftund Wochenbet[J]t.Munch Med Wochenschr 1977;119;1551.
[15]Goenka M,Kochhar R,Nagi B,et al.Rectosigmoid varices and other mucosal changes in patients with portal hypertension[J].Am J Gastroenterol 1991;86:1185
[16]李省吾.肛肠病诊治[M].上海：上海医科大学出版社,2000：45.
[17]黄乃健.中国肛肠病学[M].第一版.山东：山东科学技术出版社,1996：626-628.
[18]Jaeob DM.et al.The relationship of hemor-rhoidsros to portal hypertension[J].Dis Colonn Rectum,1980,23:563.
[19]中华医学会外科学分会结直肠肛门外科学组,痔临床诊治指南(2006版)[S],中华胃肠外科杂志：2006(5)：461-463.
[20]痔临床诊治指南(草案)[J]；中华胃肠外科杂志,2006,9(5)：461-463.
[21]唐云龙.中药内服外洗治疗内痔374例[J]；陕西中医1994年第15卷第4期.
[22]王艳梅,王宏波,李雪松.普济痔疮治疗内痔及混合制的临床观察[J].中国老年保健医学.2009,7(2)：113.
[23]Barwell J, Eatkins RM,Lloyd Davies E,et al. Life- threatening retroperitoneal sepsis after hemorrhoid injection sclerotherapy:report of a case[J]. Dis Colon Rectum,1999; 42(3):421-423.
[24]刘清德,赵杰芬.内痔注射外痔环切治疗环形混合痔[J].辽宁中医学院学报,2002,4(3)：212.
[25]荣文舟.中华肛肠病学图谱[M]；北京：科学技术文献出版社；1993：113.
[26]Murphy KJ.Tetanus after rubber band ligation of haemorrhoids[J]. Br Med J,1978; 1(6127):1590-1591.
[27]Wrobleski DE,Corman ML,Veidenheimer MC,et al.Longterm evaluation of rubber ring ligation in hermorrhoidal diseas[J]e.Dis Colon Rectum 1980;23;478.
[28]Lewis MI.Cryosurgical hemorrhoidectomy:a follow-up repor[J]t.Dis Colon Rectum 1972; 15;128.
[29]Neiger A. Hermorrhoids in everyday practice[J].Proctology 1979;2:22.
[30]Hosch SB, Knoefel WT, Pichlmeier U, et al. Surgical treatment of piles:Prospective, randomized study of Parks vs Milligan-Morgan hemorrhoidectomy[J]. Dis Colon Rectum,1998; 41:159-164.
[31]李春雨.实用肛门手术学[M].辽宁科学技术出版社,2005：112.
[32]Parks AG.Surgical treatment of haemorrhoids[J].Br J Surg 1956;43;337.
[33]Selvaggi F.Scotto di Carlo E,Silvestri A,et al.Surgical treatment of circumferential hemmorhoids[J].Dis Colon Rectum 1990;33;903.
[34]Arbman G, Krook H, Haapaniemis. Closed vs open hemorrhoidectomy—is there any diference? [J]. Dis Colon Rectum 2000; 43:61-34.
[35]Morinaga K,Hasuda K,Ikeda T.A novel therapy for internal hemorrhoids:ligation of the hemorrhoidal artery with a newly devised instrument(Moricom) in conjunction with a Doppler flow mete[J]r.Am J Gastroenterol 1995;90:610-613.
[36]Sohn N,Aronoff JS,Cohen FS,et al.Transanal hemorrhoidal dearterialization is an alternative to opreative hemorrhoidectomy[J].Am J Surg 2001;182:515-519.
[37]翁立平,季利江.超声多普勒引导下痔动脉结扎术治疗内痔的临床观察[J].结直肠肛门外科,2009；15(5)：300-303.
[38]Murphy KJ.Tetanus after rubber-band ligation[J].Br Med J,1978;(1):1590.
[39]傅传刚,张卫,王汉涛,等.吻合器环形痔切除术[J].中国实用外科杂志,2001,21(11)：653.
[40]罗湛滨,张思奋,任东林等.PPH治疗痔病的临床价值[J].大肠肛门病外科,2003,9(增刊)：4-5.
[41]姚礼庆,唐竞,孙益红,等.经吻合器治疗重度痔的临床应用价值：附36例报告[J].中国实用外科杂志,2001,21(5)：288-289.
[42]关瑞剑,赵江宁,罗湛滨,等.混合痔PPH术后5年随访分析[J].结直肠肛门外科,2009,15(4)：268.
[43]Pescatori M, Aigner F. Stapled transanal rectal mucosectomy ten years afte[J].Tech Coloproctol, 2007,16(11):1-6.
[44]成川江,王启.TST手术治疗痔病的临床观察[J].结直肠外科,2010,16(4)：240-243.
[45]林宏城,任东林,等.选择性痔上粘膜切除钉合术与痔上粘膜环切吻合术的对比研究[J].广东医学2011,32(11)：1457-1460.
[46]王业皇,章阳.开环式微创吻合器治疗呢痔病的临床效果[J].江苏医药,2010,36(11)：1249-1251.
[47]陈艳妮,江滨.PPH术后并发症的研究进展[J].结直肠肛门外科,2009,15(2)：136-138.
[48]Nobles VP.The development of the human anal canal[J].Janal 1984;138:575.
[49]张东铭,盆底与肛门病学[M].贵阳：贵州科技出版社,2000,1,17,18,25,76,144.
[50]张君曼.改良肛管扩张术治疗肛管狭窄运用探讨[J].新医学,2008,5,39,5：291-292.